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Summary Objectives To examine the experiences of clinical and managerial leaders in the English healthcare system charged with implementing policy goals of openness, particularly in relation to improving employee voice. Design Semi-structured qualitative interviews. Setting National Health Service, regulatory and third-sector organisations in England. Participants Fifty-one interviewees, including senior leaders in healthcare organisations (38) and policymakers and representatives of other relevant regulatory, legal and third-sector organisations (13). Main outcome measures Not applicable. Results Participants recognised the limitations of treating the new policies as an exercise in procedural implementation alone and highlighted the need for additional ‘cultural engineering’ to engender change. However, formidable impediments included legacies of historical examples of detriment arising from speaking up, the anxiety arising from increased monitoring and the introduction of a legislative imperative and challenges in identifying areas characterised by a lack of openness and engaging with them to improve employee voice. Beyond healthcare organisations themselves, recent legal cases and examples of ‘blacklisting’ of whistle-blowers served to reinforce the view that giving voice to concerns was a risky endeavour. Conclusions Implementation of procedural interventions to support openness is challenging but feasible; engineering cultural change is much more daunting, given deep-rooted and pervasive assumptions about what should be said and the consequences of mis-speaking, together with ongoing ambivalences in the organisational environment about the propriety of giving voice to concerns.

Additional file 2: Supplement 2. Interactive bar charts of ratings across the three stakeholder groups as presented to participants in the second Delphi round.

Additional file 1: Supplement 1. Synthesis process of the 912 responses to the recommendation task.

Meiotic crossovers reshuffle genetic material and are essential for accurate chromosome segregation. Crossovers are a product of meiotic recombination, a complex and highly regulated process, which occurs through the co-ordinated induction and repair of DNA double strand breaks. In the majority of sexually reproducing eukaryotes, the synaptonemal complex (a tripartite ultrastructure compromised of two closely apposed lateral elements adjoined by rod like transverse filaments) is installed between homologs during prophase I; this is essential for normal crossover formation. Using cytological techniques, fluorescent marker assays and novel CRISPR/Cas9 derived mutants the roles of the Arabidopsis thaliana transverse filament protein (ZYP1) were investigated. Additionally, this work also examined a candidate meiotic regulatory protein, the general transcription factor subunit TFIIFb2.This thesis reveals that in the absence of ZYP1, homologs are completely asynaptic yet chromosomes extensively and intimately align during prophase I. Furthermore, zyp1 retains near wild-type fertility and in the vast majority of cases homologs successfully and accurately crossover, though infrequently the obligate crossover is lost. This work shows that in zyp1 mutants HEI10 foci (a cytological marker of class I crossovers), counted at diplotene, are increased by ~2 fold compared to the wild type. Similarly, map lengths measured using fluorescently tagged lines were increased by ~1.5 fold in zyp1 compared to the wild-type. Despite this increase in recombination, zyp1 provides no rescue when crossed to msh5, instead zyp1 msh5 mutants show ~50% fewer chiasmata than msh5 single mutants, indicating that increased crossovers derive from the ZMM dependant class I pathway. In summary, this work reveals that zyp1 is an essential regulator of crossover control. Firstly, zyp1 is required to ensure all chromosomes receive an obligate crossover. Secondly, zyp1 is essential for the normal imposition of crossover interference which limits the occurrence of ZMM derived double crossovers.