How does poor communication result in silence? How does this happen in healthcare?

Healthcare organizations have invested in many tools to promote patient safety, but are they effective without good communication skills? Checklists, handoff protocols, warning systems, severity indexes, and other tools alone may not address the patient safety issues that face our healthcare system.
Nurses, especially in critical care areas, are confronted by these challenges daily. Often, because of the political and emotional stress that occurs when nurses raise issues with physicians, the resulting silence “undermines the effectiveness of current safety tools.” The choice to avoid a conversation can create organizational silence that leads to unfavorable results.
A 2010 survey conducted by VitalSmarts, the American Association of Critical-Care Nurses, and the Association of periOperative Registered Nurses showed that more than half of nurses had experienced situations in which they felt unsafe to speak up or unable to have others listen to them, with almost 20 percent encountering this situation multiple times per month. The incidents coincided with three general scenarios: (1) dangerous shortcuts, (2) displays of incompetence, and (3) demonstrations of disrespect.