We look to the experiences of middle managers in a health-care setting to empirically develop and explore the concept of voiced inner dialogue. Voiced inner dialogue is conceptualised as a form of reflection-on-action whereby fragments of narrative self-reflection reveal an organisation’s unspoken backdrop conversation or interpersonal mush. The normalised intensity that characterises many health-care settings, an artefact of increased governmentality and responsibilisation, leaves middle managers experiencing increased work and personal pressures. The interpersonal mush in this context is centred upon individuals’ felt disconnect between espoused and enacted organisational values. Voiced inner dialogue was triggered in dialogic conversation with the researchers, a type of participant-focused reflexivity. From our qualitative analysis, we present three themes to illuminate how organisational context can inform the creation and maintenance of interpersonal mush, impeding managers’ reflection. Voiced inner dialogue offers an opportunity for managers stuck in the silence of interpersonal mush to engage in reflection-on-action. We conclude with the implications for reflection, reflexivity and management learning.