Whistleblowing and Ethics in Health and Social Care. Angie Ash

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Whistleblowing and Ethics in Health and Social Care - Angie Ash

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person disclosing

      3.the subject of the disclosure

      4.the target of disclosure

      5.the disclosure recipient

      6.the outcome.

      Jubb regarded whistleblowing, variously, as a public act of dissent, of conflicting loyalty, a deliberate non-obligatory act of disclosure. For the purposes of this book, ‘whistleblowing’ is used in its widest sense – that is, to describe acts of speaking out to raise concerns about the standard, legality and probity of practice in health and social care, and whether these matters are raised inside or outside the organization. These may be acts of dissent, as Jubb characterized whistleblowing. The act of whistleblowing may be about an organizational system, a process, or an entire sector, such as Wigand’s disclosures on the tobacco industry in the US. Fundamentally however, whistleblowing (whether internal or external to the organization) has three defining features: first, intentional disclosure of information by an employee; second, the disclosure of concerns, malpractice or wrongdoing over which the organization has control or responsibility; and third, the purpose of the disclosure is to put right the malpractice or wrongdoing (Tsahuridu and Vandekerckhove 2008).

      Whistleblowing itself is a dynamic process, in that the dynamics between the people involved and the particular situation interact when protected disclosures are made. This way of seeing whistleblowing assumes three (or more) parties: the person doing wrong, the person observing wrongdoing and the person who receives the report of wrongdoing (Near and Miceli 1996). This triad assumes the supposed wrongdoing is committed by an individual, rather than by some, or many, behaving and acting in accord with institutional practices, such as when corrupted health and caregiving become normalized, or systemic. Although whistleblowing gets personalized – the individual whistleblower is named (and often shamed for their trouble) – the concerns they raise may be about bad, poor or dangerous practices that have become embedded, institutionally and structurally, in health and social care systems. The disaster of early twenty first-century healthcare in England at Mid Staffordshire NHS Foundation Trust was not that of a few isolated incidents, but systemic failures that many employees had tried to raise concerns about, and over a long period of time. Systematized bad practice – where workplace culture, ways of working or of treating people, becomes institutionalized and normalized – have been features of some of the worst health and social care scandals in the UK. Understanding this is critically important to prevent future harm, suffering, and sometimes death, being visited on sick or vulnerable people, and to recognize that those speaking out about harm are the organization’s early warning system of failure.

      The sort of wrongdoing or bad practice that may lead to someone whistleblowing covers a wide spectrum. Your bad practice may be my self-justified corner-cutting to get the job done, please managers and hit targets. Brown (2008) pulled out six categories of wrongdoing from a large survey into public interest whistleblowing in Australian public sector agencies:

      1.conflict of interest

      2.improper or unprofessional behaviour

      3.defective administration

      4.waste or mismanagement of resources

      5.perverting justice or accountability

      6.personnel or workplace grievances.

      This survey found whistleblowing to be more commonplace in the Australian public sector than had been expected; the most serious reported wrongdoings involved corruption, defective administration or waste.

      As to who whistleblows, spotting personality traits and individual characteristics of the whistleblower doesn’t provide a coherent picture of their profile. The search for the personality attributes, beliefs and motivations of whistleblowers yields a very mixed picture (Pemberton et al. 2012). Age is not a predictor of the propensity to whistleblow, but then employee age is usually inextricably bound up with other occupational variables, such as the employee’s length of service, experience, nature of their tenure and supervisory status. Depending on the sector and industry, for example, older employees with security of tenure and more experience may be more likely to hold supervisory positions. In a review of the 2003 US National Business Ethics Survey, Stansbury and Victor (2009) found that individuals who were both young and with short organizational tenure were less likely to whistleblow. Again in the US, Near and Miceli (1996) found that whistleblowers were older, with longer tenure and higher educational attainment, than non-whistleblowing employees; they were thus more likely to be better paid and hold supervisory status that carried with it responsibility for rectifying wrongdoing. Employees who do not see whistleblowing as part of their job are less likely to raise a concern; those holding some scrutiny responsibilities in their place of work are more likely to report wrongdoing (Miceli and Near 2005). People with higher status and positional power in the organization tend to be more experienced and better paid, and generally to be more proactive in tackling problems and raising concerns (Miceli 2004). None of these findings is personality trait based. They are situational; that is, employees occupying a particular job in an organization, and having certain status and responsibilities to sort out problems, appear more likely to raise concerns.

      The significant finding of Brown’s Australian survey mentioned above, and others, is that with one exception there is little to distinguish whistleblowers from non-whistleblowers. You can hardly tell them apart on any of the usual matrices that differentiate employee competencies, skills and propensities. Whistleblowers hold the same attitudes about their workplace, about their job and about their managers as those who remained silent. Almost anybody in this survey could be expected to speak up and not – as retribution attacks by the organization on the whistleblower would have us believe – just those who were bitter, passed over for promotion or looking for a fight. By the same token, almost any employee could stay silent in the face of wrongdoing. Just one characteristic set those who spoke out apart from others, and that was the high level of ‘organizational citizenship behaviour’ they displayed – that is, they cared about the organization and took their role as part of it very seriously (Brown 2008).

      So it is not simple to spot who will whistleblow. If an employer wanted to select (or deselect) people likely to speak out about wrongdoing, they could not easily pinpoint the killer qualities of the whistleblower. Attempts to identify individualized personality traits that set the whistleblower apart from their peers have generally been disappointing. Stansbury and Victor (2009) found that ‘prosocial’ behaviours (behaviour motivated by altruism as well as self-interest, and intended to benefit the public or social good), when reinforced and informally normalized in the workplace, were more likely to increase whistleblowing activity. Younger and short-tenured employees were less influenced by this prosocial control, suggesting that this is learned and reinforced over time in the workplace. As with the organizational citizenship behaviour found in Brown’s (2008) study, when an employee displays prosocial behaviour – when they care about what they do and want to benefit the public or social good – they are more likely to raise concerns about practice. This prosocial behaviour needs an environment in which it is cultivated and valued: an organization and employer that is prosocial, and displays citizenship behaviour in what it does, and how it does it. Context counts.

      The power of the context to influence whether employees speak out about concerns cuts both ways. Low-wage sectors and deregulated labour markets (as are significant parts of the US and UK economies), characterized by job insecurity and with limited, if any, employment protection, employing younger employees and women with young children, are more likely to be deterred from raising concerns (Zipparo 1999). Thus pre-existing structural inequalities impact on employee propensity to blow the whistle. Keeping children fed, warm and clothed while working antisocial hours in more than one minimum wage, zero hours job dampens down the appetite for upsetting the precarious applecart that is job (in)security.

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