Feeling Respected at Work Cuts Fear of Speaking Up by 71 Percent, Study Finds

In the high-pressure world of modern healthcare, the difference between a near-miss caught in time and a tragedy often comes down to a single question: will someone speak up? A new study of nearly 2,700 employees at an academic health sciences campus suggests that the answer may hinge less on individual courage and more on something organizations can actually control, namely whether their people feel genuinely respected. Researchers analyzing survey data from the University of Utah Health Sciences campus found that employees who perceived their organization as respectful and inclusive were dramatically less likely to fear retribution for voicing their opinions, with each one-point increase in perceived organizational respect on a five-point scale associated with roughly 71 percent lower odds of fearing retaliation.

Fear of retribution, the apprehension that expressing concerns may trigger retaliation, damaged relationships, or professional setbacks, has long been recognized as a silent killer of employee voice. In healthcare settings, the stakes are unusually high, because communication failures can directly compromise patient outcomes. When nurses, physicians, technicians, and staff hold back observations about safety problems, the entire institution loses access to information it desperately needs. The new research, published in the journal Heliyon, formally tested whether perceived organizational respect, defined as the degree to which employees feel valued and fairly treated regardless of demographic identity, is associated with this fear-based silence.

The study drew on a confidential April 2019 employee engagement survey administered through the Waggl feedback platform, which drew approximately 2,692 respondents, a response rate of about 36 percent. Participants included academic faculty, academic non-faculty employees, and staff across the health sciences campus, not only clinicians who provide direct patient care. Two single-item measures anchored the analysis. Employees rated their agreement with the statement that their organization values and respects employees across gender, race, age, religion, ability, and other dimensions, and separately with the statement that they could express their opinions without fear of retribution, both on five-point Likert scales.

The statistical approach was deliberately layered to test three hypotheses. First, the researchers modeled fear of retribution as a binary outcome, classifying respondents as fearing retribution if they disagreed or strongly disagreed that they could express opinions without fear. Second, they adjusted the association for age, gender, race and ethnicity, and employee role to check whether any of these demographics acted as strong confounders. Third, they tested whether the association differed across demographic strata by adding interaction terms. A Pearson correlation of negative 0.55 between the two constructs provided an early signal of the strong inverse relationship the team hypothesized.

The results were striking in their magnitude and consistency. In the fully adjusted logistic regression model, which included 2,664 complete cases, each one-point increase in perceived organizational respect was associated with approximately 71 percent lower odds of fearing retribution, an adjusted odds ratio of 0.29 with a 95 percent confidence interval of 0.25 to 0.33 and a p-value below 0.0001. Notably, none of the demographic covariates reached statistical significance in the adjusted model. The confounding analysis showed that adding each demographic variable changed the respect effect estimate by less than 10 percent, with age shifting it by 3.6 percent, gender by 0.5 percent, race and ethnicity by 0.9 percent, and employee type by 1.2 percent.

Model performance comparisons underscored just how much of the predictive signal came from perceived respect rather than demographics. A model containing only age, gender, race and ethnicity, and employee role explained a trivial 0.47 percent of variance and achieved an area under the receiver operating characteristic curve of just 53.66 percent, barely better than a coin flip. The respect-only model, by contrast, explained 27.23 percent of variance with an AUC of 77.78 percent, and adding demographics nudged those figures only modestly upward to 27.83 percent and 78.76 percent. In other words, how respected employees felt was overwhelmingly the dominant correlate of whether they feared retaliation, dwarfing every demographic characteristic measured.

Perhaps the most intriguing finding was what did not appear: meaningful moderation. Interaction tests revealed that the association between respect and fear of retribution did not differ significantly across age groups, genders, racial and ethnic categories, or employee roles. At the same time, perceptions of respect themselves varied across groups. Female employees were less likely than male employees to agree that the organization was respectful, at 80.6 percent versus 84.6 percent, White employees reported higher perceived respect than Asian employees or those in the underrepresented in medicine group, and academic non-faculty employees reported the lowest perceived respect of any role. These patterns echo a substantial literature documenting isolation, invisibility, and disproportionate service burdens among women and underrepresented faculty in academic medicine.

The findings align closely with psychological safety theory, the influential framework developed by Harvard’s Amy Edmondson, which holds that speaking up is an interpersonal risk that employees take only when they believe their environment can absorb it. The authors argue that perceived organizational respect functions as a measurable organizational-level perception that feeds directly into this risk calculus. Yet they are careful to note the limits of the evidence. Because the study was cross-sectional, it cannot establish that boosting respect reduces fear of retribution; the causality could plausibly run in the opposite direction, with organizations that welcome dissent cultivating more respectful climates as a byproduct. Nor does the study demonstrate that greater respect translates into better patient-safety outcomes, since recent systematic reviews indicate that the link between psychological safety and objective safety measures is complex and context dependent.

Several methodological caveats temper the conclusions. Both key constructs were measured with single items, a pragmatic choice common in enterprise engagement surveys that recent methodological syntheses support but which limits construct validity and dimensional analysis. The sample was drawn from a single institution and was predominantly White, and the 36 percent response rate raises the possibility of non-response bias if employees with unusually positive or negative experiences were more inclined to participate. Aggregating several smaller racial and ethnic groups into a single underrepresented category may have masked within-group differences, and the survey collected no information on religious affiliation, sexual orientation, or disability status, leaving intersecting identities unexplored.

Even so, the practical implications are hard to ignore. For leaders of hospitals and academic medical centers, organizational respect emerges as a concrete, measurable lever, one that already appears in standard engagement surveys and correlates powerfully with employees’ willingness to raise concerns. The authors recommend respect-centered interventions evaluated with rigorous experimental or quasi-experimental designs, longitudinal multilevel studies tracking how team and organizational climates shape voice over time, and comparative research on single-item versus multi-item measurement instruments. Whether fostering an inclusive, respectful culture can genuinely loosen the grip of fear-based silence, and in turn protect patients, is now a testable question that health systems around the world have every reason to pursue.

Subject of Research: The association between perceived organizational respect and fear of retribution among healthcare campus employees

Article Title: The association between perceived organizational respect and fear of retribution

Article References: Carter, G., Morrow, E., Locke, A., Call, M. E., Van Epps, J., Rodríguez, J. E., & Qeadan, F. (2026). The association between perceived organizational respect and fear of retribution. Heliyon, 12(15), Article e45578. https://doi.org/10.1016/j.heliyon.2026.e45578

Image Credits: AI Generated

DOI: 10.1016/j.heliyon.2026.e45578

Keywords: psychological safety, employee voice, fear of retribution, organizational respect, healthcare, workplace silence, academic medicine, survey research, logistic regression, inclusion, employee engagement, patient safety