Purpose In recent years, in research and policy circles, there is growing interest in the subject of speaking up (and silence) within the health sector, and there is a consensus that it is a major issue that needs to be addressed. However, there remain gaps in our knowledge and while scholars talk of a voice system – that is the existence of complementary voice channels designed to allow employees to speak up – empirical evidence is limited. We seek to explore the notion of a voice system in a healthcare organisation as comprising structures and cultures as seen from different stakeholder perspectives. What do they see and how do they behave and why? To what extent do the users see a voice system they can access and easily navigate?

Design/methodology/approach Interviews and focus groups were conducted with a voice stakeholder group (e.g. designers of the system from senior management and HR, which comprised 23 staff members) as well as those who have to use the system, with 13 managers and 26 employees from three units within a metropolitan hospital: an oncology department, an intensive care unit and a community health service. Overall, a total of 62 staff members participated and the data were analysed using grounded theory to identify key themes.

Findings This study revealed that although a plethora of formal voice structures existed, these were not always visible or accessible to staff, leading to confusion as to who to speak up to about which issues. Equally other avenues which were not designated voice platforms were used by employees to get their voices heard.

Originality/value This papers looks at the voice system across the organisation rather than examining a specific scheme. In doing so it enables us to see the lived perceptions and experiences of potential users of these schemes and their awareness of the system as a whole.