Thought Pieces

Whistleblowing exists where governance fails

Whistleblowing exists where governance fails

Whistleblowing exists where governance fails banner icon

Whistleblowing remains an important mechanism in healthcare, but it is one which is deeply problematic for whistleblowers themselves (many of whom feel they have no other option but to take this route) for organisations, and for the NHS generally. During our many years of experience in reviews and investigations, Niche have found that cases of whistleblowing can almost always be attributed to a failure of governance. However, there are:

• many ways to support raising concerns without whistleblowing being the eventuality;
• better ways to deal with whistleblowing when and if it happens.

The context of NHS culture

Whilst there has been a demonstrable increase in verbal and procedural commitments to openness since Robert Francis completed his Freedom to Speak up Review in 2015, there remains a significant lack of true progress towards developing a culture of “radical honesty.” By this we mean a culture where concerns can be raised with candour, within a just culture, and acted upon in a shared spirit of continuous quality improvement.

Whistleblowing in the media

Instead, the cases of whistleblowing which make it into the media often describe just the opposite. Many are whistleblowers who report being marginalised and have suffered detriment; but one side of the story often remains unheard. Individuals within organisations can also suffer detriment, those accused, those working within the services and those handling the cases. This is in addition to reputational damage for whole services, organisations and the act of ‘speaking up’ itself; this is all indicative of the (currently) very flawed and fragile system of raising concerns. The non-whistleblowers voice is rarely heard, in what is often presented in the media as heroic Davids battling fierce Goliaths. Protected disclosure, public interest, fears of legal action and the fear of adverse media all prevent a fully rounded and unbiased view from emerging, a view which helps the NHS to learn. The challenges that organisations face in addressing cases of whistleblowing (often continuing over several years) are rarely surfaced, which can result in a very myopic view of the process being upheld within the public conscience. Fear surrounding whistleblowing as well as a failure to learn prevents the NHS from developing ‘secure’ handling surrounding ‘speaking up’ and this is a real threat to patient safety.

How raising concerns escalates into whistleblowing crisis for an organisation
Whistleblowing is usually a direct representation of governance which has failed. It is not usually the first resort option available to staff (and should not be employed as such) – it is the last, and usually happens when all other avenues of redress have failed. A unifying characteristic of most cases is that they were managed poorly and without sufficient independence from the outset; this is ‘insecure handling’. When insecure handling progresses; this can create compound damage and all parties can suffer detriment.

Indications that an organisation is not handling concerns securely can be seen when senior leaders:

  • Assume that early concerns (usually raised some time before the episode of whistleblowing) will somehow ‘work themselves out’…
  • Assign concerns simply to ‘team dysfunction’ and ‘conflicting personalities’ (this can quickly become allegations of racism, sexism and favouritism)…
  • Spend too much time trying to assess the motives of the individual raising concerns: ‘what do they really want?’ or, ‘they are raising concerns in retaliation’… This can cause topic ‘bleed’ becoming less about the concerns that were raised and more about the tribunal, the Inquest, the money or the person
  • Try to ‘keep the issues localised’ and not let them spill up to the Board or outside of the organisation, to, for example, the CQC
  • Allow rumours to start by failing to apply confidentiality, partisan behaviours can start to develop where people ‘take sides’ despite having little or no knowledge of the actual evidence (some of which cannot always be reported)
  • Fail to act decisively, to ensure the issues are properly investigated and that the evidence is identified and utilised properly, without bias
    Allocating too much time to ‘managing the message’ and ‘closing the issue down’, this can often contribute directly to the issue becoming louder and more volatile.

Often, we see lawyers becoming involved from both parties as relationships deteriorate and legal arguments about process quickly supersede the original concern. All of these ‘insecure’ approaches can lead to an unrecoverable loss of trust between the individual raising concerns and the organisation. This loss of trust can be pervasive, extending to all aspects of subsequent case handling; resolution becomes unobtainable. There must be thousands of NHS hours spent dealing with issues surrounding whistleblowing which could be much better utilised on making the improvements required.

Handling concerns in ways which support the safe surfacing of the facts

‘Secure’ handling would see a reversal of the above key points. Prompt and early intervention; concerns which are taken seriously; impartial involvement from the start (not from a lawyer); confidential handling of information throughout; early and sincere feedback to the person raising concerns; the correct remedy proposed and implemented; and demonstrable improvements to patient safety. Secure handling requires solid protocols which cover all eventualities around how concerns are raised; via the line-manager, via hotline, in-person or anonymously (the latter seems to create a particular and unhelpful type of focus).

We rarely hear about ‘speaking up’ cases which have been handled in a ‘secure’ way – because they often don’t result in whistleblowing. The ability of individuals to raise concerns about their services and organisations requires a mature culture which has a focus upon radical honesty. A culture of radical honestly requires civility, responsiveness, and an absolute and unequivocal commitment to patient safety from all parties.

Learning and preventing

To draw useful learning from cases of whistleblowing organisational leaders must:

1. See each case of whistleblowing as an audit of the effectiveness of governance

Every single case of Whistleblowing should attract a corresponding audit of all of the steps and avenues which should have provided a better and more productive outcome for both the whistleblower and the organisation. Establish the earliest point that the member of staff (or team) could have been listened to, and what actions should have been taken to address the concerns properly at an earlier stage.

2. Ensure secure processes for case-handling

Avoid conflicts and a lack of impartial handling. If people raising concerns feel that leaders of an investigation “have an agenda” this will damage the process, especially as some people will have very little trust from the start. Organisations struggle with the dual role of arbitrator and defender of organisational interests, and this is where an independent view is essential; lawyers are rarely helpful in this regard. Make sure that information is treated with respect, and that evidence required is gathered thoroughly, as omissions (actual or perceived) can be very damaging at later stages when relationships are under stress. Opportunities for gossip must be minimised.

3. Work towards a culture of radical honesty.

Developing a culture of radical honesty between individuals, teams, services, and organisations is key to the positive handling of concerns at an early stage. The NHS must be able to safely surface the truth if service quality and a just culture is to be maintained and improved. Developing such a culture requires strong leadership at all levels and those individuals must exhibit role-model behaviours. People must see concerns being handled with respect in order to have faith that they will be heard if they are compelled to speak up.

More open learning like this will help to ensure that concerns are addressed at a much earlier stage within a culture of radical honesty. Staff will feel much safer in raising concerns, the public will have more confidence, and there will be a virtuous cycle of improvement surrounding patient safety and healthcare governance.

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