"Whistle while you work – if you dare” - Health Service Journal
Image copyright, Malcolm Willett Terms used Different terms are used to describe raising concerns or highlighting problems/wrongdoing in an organisation. ‘Whistleblowing’ is just one of those terms. In “A time to speak: Diary of an NHS whistleblower” Pink (2013) actually prefers the term of ‘truth telling’. He does not think that staff are able to tell the truth in the NHS. Glazer and Glazer (1989) use the term ‘ethical resistance’ in the context of whistleblowers exposing corruption in government and industry. ‘Silence breaking’ is a phrase used by Zerubavel (2006) to denote revealing of “...open “secrets” of which we are aware yet unwilling to publically acknowledge” (p.65). This is in contrast to whistleblowing with the revealing of “...ordinary secrets” where people are not aware. Silence breakers help to “...uncover “elephants” rather than the “skeletons” a whistleblower might bring to light” (p.65). ‘Background’ information is publicised rather than ‘backstage’ information. Under the definition of Zerubavel it is possible that many, perhaps most situations in the NHS, could come under the category of ‘silence breaking’, rather than ‘whistleblowing’. People may know, but don’t want to acknowledge. "...the whole iceberg thing" It can be very difficult to raise concerns about patient or staff welfare in the NHS. Using the contributions from the research participants the diagram below reflects the layers of possible response and behaviour in the NHS. At the top are the high profile whistleblowers/silence breakers who refuse to be 'gagged'. At the bottom is the "sea of silence" and the "silent majority". Those staff members who do raise concerns run the risk of being victimised. Careers can be destroyed.
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'Resistance to knowing'
Participants used interesting descriptive words/phrases and metaphorical language when describing their observations and experiences: "It’s very ‘Hear no, see no, speak no’...So they hear nothing, they see nothing and they say nothing. They don’t tell us what is going on and don’t listen to what we are saying and they choose to ignore it if you do it in e-mail. So they cannot see it". "The amount of people who don’t get that e-mail" "If I stick my fingers in my ears and hum loudly, then it’s not happening" "…deep culture of cover up of bad news, maximum gloss etc" |
The Consultant journal has an interesting image to represent 'Leadership blindness'. Those 'Ostriches with their heads in the sand' reflect the tendency of the NHS to reject and avoid 'bad news'. |
"The key, um, critique being Hans Anderson story about ‘The Emperor’s New Clothes’, King’s new clothes. It takes a little boy to say, but, yeh, look what’s going on. And all that drives the culture of the NHS. Thou shalt not break the golden rule".
"And the ‘golden rule’ is?" "The golden rule is 'keep stum’, don’t let it out" |
The inquiry reports into the disaster at Mid Staffordshire hospital (Francis, 2010 and 2013) revealed that people did try to raise concerns about poor patient care. "The tragedy was that they were ignored" (2010, p.3). The 'Freedom to speak up' review was published in 2015. "...there is a culture within many parts of the NHS which deters staff from raising serious and sensitive concerns" (Francis, 2015, p.8). "Bullying and oppressive behaviour was mentioned frequently, both as a subject of concern and as a consequence of speaking up" (p.10). There were "...more references to bullying in the written contributions than to any other problem" (p.12). "...the power imbalance inherent in organizational roles is perhaps the most important factor that makes employee silence such a common experience" (Morrison and Rothman, 2009, p.112, italics in original). In "Whistleblowers: Broken lives and organizational power" Alford (2001) considers that whistleblowers offer truths which are "...experienced as a threat to power" (p.3). To "...run up against the organization is to risk obliteration" (p.4). |