New paper – modelling “internal whistleblowing” in healthcare
The paper makes a distinctive contribution to the debate about speaking-up (or ‘internal whistleblowing’ as referred to in the paper). It was an interesting challenge to work on a different approach to generating and analysing data. Agent based modelling is a computational modelling approach, which simulates the actions and interactions of both individual or collective entities (such as organizations or groups) and assessing their effects on the system as a whole.
The work focuses on how different speaking-up rates compare with each other in a variety of environments. These models also demonstrate how much institutional nuances can alter the effectiveness of a given speaking-up rate.
Internationally, healthcare staff are being encouraged and supported to raise and respond to concerns in the workplace (see here for an example from a previous post). Given this, the paper aims to answer questions such as:
- Are resources within the system able to cope with potentially hundreds or thousands of complaints per month?
- What are the effects, if any, of any delays in responding to concerns on patient care and on employees’ propensity to raise concerns in the future?
- Will patient care improve as a result of speaking-up?
The paper calls into question the a priori belief that speaking-up always improves patient care. Given resource constraints, whistleblowing /speaking-up policies should seek to understand the complex relationship between accuracy of information, efficiency in responding to concerns, formal and informal speaking-up channels and the utility of speaking up.
The results show that an optimal model for speaking-up include:
- Organisations where employees’ practices are fully transparent to others and employees within an organisation have a propensity to raise concerns;
- When introducing roles such as Freedom to Speak Up Guardians, organisational resources and efficient processes are required to ensure concerns are responded to in a timely way. Inefficient processes and response delays suppress speaking-up;
- It is almost always beneficial to encourage and permit informal channels for speaking up. A combination of informal and formal speaking-up processes perform better than formal speaking-up in isolation. Cheap, timely and informal but less transparent and possibly accurate channels for speaking-up, mixed with more accurate, formal but costly channels leads to excellent patient care.