Whistle-blowing and workplace culture
Inquiries in the UK into mistreatment of older people by healthcare employees over the last 30 years have focused on introducing or supporting employee whistle-blowing. Although whistle-blowers have made an important contribution to patient safety it remains a controversial activity.
Deafening silence? Time to reconsider whether organisations are silent or deaf when things go wrong
Several public inquiries into healthcare failings in the UK have noted that employees of failing organizations attempt to raise concerns about shortcomings in care, often over a prolonged period of time, only for those concerns to be ignored. However, healthcare literature has largely focused on how organizations and their employees are silent in the face of such failings, positioning employees as daring not to speak in response to serious workplace problems or issues. We argue that only focussing on organizational silence is a critical mistake which misrepresents actual events and overly-simplifies the complexities of workplace culture. The disregard shown by academics, practitioners and policy makers to employee voice strategies, which do not amount to whistle-blowing, but equally cannot either be defined as “silence”, results in signals being ignored that can be effective in preventing and ending wrongdoing by others. In addition to understanding silence we suggest therefore that better understanding of why organizations are deaf to, or disregard, employee concerns are needed. We propose that a virtuous cycle is possible, whereby the introduction of systems that result in better listening and valuing of employee concerns reinforces a culture of speaking up and, in turn, organizational learning. Similarly, organizations that disregard employees concerns are destined not to learn, ultimately falling silent and failing.
Giving voice to safety at board level
Background: Recent reports into egregious failing in the quality and safety of healthcare in the UK have focussed on the ability of executive boards to discharge their duties effectively. Inevitably the role of executive nurses, whose remit frequently includes responsibility for quality and safety, has become the object of increased scrutiny. However, limited evidence exists about the experiences of the UK’s most senior nurses of working at board level.
Objective: We aimed to generate empirical evidence on the experiences of executive nurses working at board level in England and Wales. We posed two research questions: What are the experiences of nurse executives working at board level? What strategies and/ or processes do nurse executives deploy to ensure their views and concerns about quality and safety are taken into account at board level?
Design: Qualitative interviews using semi-structured interviews.
Setting: NHS England and Wales.
Participants: Purposive sample of 40 executive board nurses.
Methods: Semi-structured interviews followed by a process of thematic data analysis using NVivo10 and feedback on early findings from participants.
Results: Our findings are presented under three headings: the experiences of executive nurses working with supportive, engaged boards; their experiences of being involved with unsupportive, avoidant boards with a poor understanding of safety, quality and the executive nursing role and the strategies deployed by executive nurses to ensure that the nursing voice was heard at board. Two prominent and interrelated discursive strategies were used by executive nurses – briefing and building relationships and preparing and delivering a credible case. Considerable time and effort were invested in these strategies which were described as having significant impact on individual board members and collective board decision making. These strategies, when viewed through the lens of the concept of ‘‘groupthink’’, can be seen to protect executive nurses from accusations by board colleagues of disloyalty whislt also actively restricting the development of ‘‘groupthink’’ within the board.
Another finding of note was that executive boards may not be permanently fixed as either unsupportive or supportive as participants described how certain boards that were initially unsupportive adopted a more supportive attitude towards matters of safety and quality.
When care is needed
The paper focusses on the actions of employees within organizations (such as hospitals
or domiciliary care organizations) or professional groups (such as nurses and doctors) but does not include
reference to whistleblowing or the raising of concerns by members of the public (such as relatives
The Role of Employee Whistleblowing and Raising Concerns in an Organizational Learning Culture
It is inevitable that healthcare workers throughout their careers will witness actual or potential threats to patient
safety in the course of their work. Some of these threats will result in serious harm occurring to others, whilst at
other times such threats will result in minimal harm, or a ‘near miss’ where harm is avoided at the last minute.
Despite organizations encouraging employees to ‘speak up’ about such threats, healthcare systems globally
struggle to engage their staff to do so. Even when staff do raise concerns they are often ignored by those with a
responsibility to listen and act. Learning how to create the conditions where employees continuously raise and
respond to concerns is essential in creating a continuous and responsive learning culture that cherishes keeping
patients and employees safe. Workplace culture is a real barrier to the creation of such a learning system but
examples in healthcare exist from which we can learn.
Raising concerns in the workplace
Three pieces of evidence underpin the report. The first
is an extensive piece of research carried out for the
Commissioner by Cardiff University, giving voice to front line
staff on the subject of workplace culture in health and social
care settings and how it can support or prevent the raising of
concerns. The second is a short report by Public Concern at
which looks at the data it has gathered over the past
ten years from health and social care workers in Wales who
contacted their helpline. The third is evidence gathered from
individuals who contacted the Commission in response to
a call for evidence from those who have had experience of
Raising concerns and reporting poor care in practice
This article considers the issue of poor care and how nurses should respond when they encounter
it. Several reports and inquiries into failings in care have called into question the standards of
care provided by nurses. Of equal concern is the observation that in some instances, poor care
is unreported. While there may be underlying structural and organisational reasons for this, it is
contended that nurses have a legal, moral and professional obligation to report poor care when
they become aware of it