The voice of sacrifice: The silence of healthcare professionals in the service of productivity. The case of a French hospital

Abstract

For more than half a century, French hospitals have been subjected to the logics of New Public Management (NPM), which compel healthcare professionals to navigate increasing demands for economic efficiency. Rooted in a managerial ideology, these logics generate significant distress among healthcare professionals, who struggle to reconcile the socio-relational aspects of care with new standards of standardization dictated by performance tools and indicators. While this distress remains a taboo in hospital settings, this study examines how the silence surrounding professional suffering becomes a lever for productivity within these managerial frameworks. Drawing on ethnographic research conducted through observations and interviews in a French hospital specializing in severe liver and pancreatic diseases, our findings reveal that silence, initially imposed by a managerial culture that denies vulnerability, evolves into a resource for healthcare professionals. It allows them to transcend their subjectivity to meet productivity demands. Grounded in the theory of the psychodynamics of work, we argue that healthcare professionals use silence as a means of self-sacrifice, aiming to fulfill productivity expectations and conform to identity norms shaped by the organizational culture.