Despite the inseparable nature of power and knowledge, voice and silence research has focused on the detrimental effect of hierarchical power on voice without disentangling how knowledge and hierarchy interrelate in shaping voice and silence. Addressing this gap, we analysed 67 multidisciplinary professional interviews in surgical teams in Ghana. We found that knowledge provides a strong authority for voice among surgical teams quite independent of hierarchy. While knowledgeable team members with substantial hierarchical power effectively exercised upward voice, hierarchical caveat over knowledge and uncertainty limited lower hierarchies from utilising their knowledge for voice in authority gradient. Whereas knowledgeable superiors welcomed voice, those who are deficient in knowledge and expertise were less receptive to voice thereby posing a significant impediment for upward voice. Finally, a small cadre of distinguished ‘medical ‘gods’ who are revered for their rare knowledge status commanded voice authority among their peers, and their eminent status served to suppress the psychological safety of wider team members for voice. We conclude that formal hierarchical authority and knowledgeability are anchored within surgical teams and understanding the complex interplay between knowledge and hierarchy is crucial to implementing effective interventions to promote voice in such knowledge-intensive and highly status-conscious environments. Keywords: Hierarchy; Knowledge, Power, Voice and Silence; Patient Safety; Surgery; Ghana
