Our new study from Pakistan’s public-sector Medical Teaching Institutions reveals how values, psychology, and safety culture combine to keep healthcare workers quiet, or help them speak up.
Imagine a nurse who notices a medication error about to happen but says nothing. Or a junior doctor who sees a procedure being done incorrectly but stays silent out of fear. This is not a rare scenario, it is one of the most persistent and dangerous problems in healthcare organizations worldwide. It even has a name: organizational silence. Our new study published in the Dialogue Social Science Review asks a provocative question: could cultivating spirituality in the workplace be part of the answer? (Yaqub & Afridi, 2026)
The Problem: When Quiet Becomes Dangerous
Organizational silence is defined as the deliberate choice by employees to withhold ideas, concerns, or assessments that could benefit their organization (Morrison & Milliken, 2000). It is not passive indifference, it is an active decision to stay quiet, often driven by fear of consequences, a sense that nothing will change anyway, or a feeling that one’s voice simply does not matter.
In most workplaces, silence costs innovation and learning. In healthcare, it can cost lives. When staff do not report errors, flag unsafe practices, or raise concerns about process inefficiencies, the consequences can be severe, for patients and for the institutions meant to serve them (Kassandrinou et al., 2023).
Existing research on why employees go silent has focused heavily on leadership styles, organizational hierarchy, and power distance. But our recent research, argue that this picture is incomplete. This study introduces a value-based and psychological lens to examine silence, one that centers workplace spirituality, locus of control, and psychological safety (Yaqub & Afridi, 2026).
The Framework: Three Key Concepts
1. Workplace Spirituality
This has nothing to do with religion. Workplace spirituality, as defined in organizational behavior research, refers to an employee’s sense of meaning and purpose in their work, their feeling of community and connectedness with colleagues, and the alignment between personal and organizational values (Ashmos & Duchon, 2000). Think of it as the difference between having a job and feeling that your work matters, and that you belong to something larger than yourself.
Research consistently links workplace spirituality to increased well-being, job satisfaction, and organizational engagement (Chandra & Kumar, 2025). This study asks whether it also reduces silence, and finds that it does, significantly.
2. Locus of Control
Locus of control is a psychological concept introduced by Julian Rotter in 1966. It describes the degree to which a person believes that outcomes in their life are shaped by their own actions (internal locus) versus by external forces like fate, chance, or other people (external locus) (Rotter, 1966).
Employees with a strong internal locus of control believe their input matters and that speaking up can actually make a difference. Those with an external orientation are more likely to feel that raising concerns is futile or even risky, and so they stay silent (Mareta et al., 2023). The researchers propose that workplace spirituality boosts internal locus of control, and that this is one key mechanism through which it reduces silence.
3. Psychological Safety
Psychological safety, the shared belief that it is safe to take interpersonal risks at work, has been one of the most studied concepts in organizational research since Amy Edmondson’s foundational work in the 1990s (Edmondson, 1999). Psychologically safe employees feel they can voice concerns, admit mistakes, and challenge existing practices without fear of punishment or humiliation.
This study positions psychological safety as a moderator: its presence or absence changes how powerfully workplace spirituality reduces silence. The intuition is compelling, even spiritually engaged employees with a strong sense of agency may not speak up if they sense that the organizational climate will punish them for doing so (Yaqub & Afridi, 2026).
“Organizational values are not enough without the backing of a climate that reduces the fear of adverse effects.” Yaqub & Afridi, 2026
The Study: Who, Where, and How
The research was conducted in public-sector Medical Teaching Institutions (MTIs) in Pakistan, hierarchical, bureaucratically structured healthcare settings where silence behaviors are especially consequential and especially understudied in the academic literature. A total of 400 employees across various functional areas and job levels participated, completing a structured questionnaire using validated measurement scales from established prior research (Yaqub & Afridi, 2026).
The data was analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) via SmartPLS, a technique well-suited to complex models involving both mediation and moderation, particularly when data may deviate from normal distributions (Hair et al., 2022).
What the Data Shows?
H1 — Workplace spirituality significantly reduces organizational silence (Supported) Employees in spiritually enriched environments were considerably less inclined to withhold ideas and concerns. The path coefficient was β = 0.507 (t = 5.726), confirming a strong direct effect (Yaqub & Afridi, 2026).
H2 — Locus of control mediates the relationship (Supported) Workplace spirituality boosts employees’ internal sense of control, and this increased agency in turn reduces silence. The mediation path was significant at β = 0.388 (t = 6.204, p < 0.001), confirming that spirituality works partly by strengthening how responsible and influential employees feel at work (Yaqub & Afridi, 2026).
H3 — Psychological safety moderates the relationship (Supported) The interaction term was significant (β = 0.324, t = 2.701, p = 0.001), showing that the silence-reducing effect of workplace spirituality is amplified when employees feel psychologically safe (Yaqub & Afridi, 2026).
Moderated mediation confirmed The conditional indirect effect, spirituality reducing silence via locus of control, with psychological safety moderating that path, was also confirmed (β = −0.024, t = 2.378, p = 0.017). The chain from values to silence through personal agency works best when psychological safety is high (Yaqub & Afridi, 2026).
The model’s explanatory power was striking. The R² for organizational silence was 0.928, meaning the combined predictors account for over 92% of variance in silence scores, an exceptionally strong result for a behavioral study of this kind.
What This Means for Healthcare Leaders?
The practical prescription is threefold (Yaqub & Afridi, 2026):
First, invest in meaningful work. Organizations that help employees connect their daily tasks to a larger sense of purpose, through mission-driven culture, shared values, and genuine community, are actively reducing the risk of dangerous silence. This is not soft management theory; the data back it up.
Second, cultivate internal locus of control. Management practices that extend real autonomy, involve staff in decision-making, and signal that their input shapes outcomes build a sense of personal agency. When people believe that speaking up can change things, they are far more likely to do so (Mareta et al., 2023).
Third, and most critically: none of this works without psychological safety. A spiritually nourishing workplace and an empowered workforce will still go silent if the climate punishes mistakes or dismisses dissent. Supportive leadership, non-punitive error reporting cultures, and open feedback channels are not optional extras, they are the conditions under which everything else functions (Edmondson, 1999).
“Not only external organizational conditions influence silence behavior, but also internal perceptions of meaning, power, and both personal and interpersonal safety of employees.” Yaqub & Afridi, 2026
Limitations and the Road Ahead
We (the authors) are candid about the study’s boundaries. As a cross-sectional survey, it captures a single moment rather than tracking how these dynamics evolve. The findings are specific to public-sector healthcare in a developing-country context, where hierarchical structures are particularly pronounced, and may not transfer directly to other industries or settings without further testing (Yaqub & Afridi, 2026).
The researchers call for longitudinal designs to observe how spirituality and silence behaviors shift over time, replications across diverse cultural and industry contexts, and qualitative or mixed-method work to illuminate the lived experiences behind the statistics.
The Bigger Picture
This study matters beyond its specific setting. It challenges the dominant narrative in silence research, which has long framed the problem as primarily one of leadership style or structural power and introduces a more holistic account. Organizational silence is also a spiritual and psychological problem. When people find no meaning in their work, feel no agency over outcomes, and fear the consequences of speaking, silence becomes the rational choice (Morrison & Milliken, 2000; Kassandrinou et al., 2023).
Conversely, when organizations invest in meaning, foster agency, and build genuinely safe climates, they create the conditions for voice, and, in healthcare settings, potentially for saving lives, is a finding worth taking seriously.
References
- Ashmos, D. P., & Duchon, D. (2000). Spirituality at work: A conceptualization and measure. Journal of Management Inquiry, 9(2), 134–145.
- Chandra, S., & Kumar, S. (2025). Workplace spirituality and employee well-being: A systematic literature review. Mind and Society, 14(2), 55–66.
- Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350–383.
- Hair, J. F., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2022). A primer on partial least squares structural equation modeling (PLS-SEM) (3rd ed.). Sage Publications.
- Kassandrinou, M., Meijerink, J., & Bondarouk, T. (2023). Employee silence and voice: A systematic review. European Management Journal, 41(2), 252–267.
- Mareta, M., Alola, U. V., Avci, T., & Ozturen, A. (2023). Locus of control and employee voice behavior. International Journal of Hospitality Management, 110, 103448.
- Morrison, E. W., & Milliken, F. J. (2000). Organizational silence: A barrier to change and development in a pluralistic world. Academy of Management Review, 25(4), 706–725.
- Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs, 80(1), 1–28.
- Yaqub, M., & Afridi, F. K. (2026). Workplace spirituality and organizational silence: A moderated mediation analysis of psychological safety and locus of control. Dialogue Social Science Review, 4(3).