are typically on minimum wage. The use of agency staff in health and social care services is widespread. These are not job conditions that encourage whistleblowing.
Even though they coined the term ‘ethical resister’, Glazer and Glazer (1989) agreed that the decision to report wrongdoing could not be attributed only to an individual’s personal propensity to do so, or to any identifiable, innate features predisposing one person to raise concerns but not another. Jeff Wigand, the scientist who exposed the duplicity and corruption of the tobacco industry in concealing and misrepresenting data about smoking-related death rates, said there was no great epiphany for him when he went public with his concerns. Wigand came to regard what he did as an ethical decision, an incremental process of unsuccessfully raising concerns inside the organization, and then taking them outside the tobacco industry (Armenakis 2004).
There is, then, no clear profile of the ‘typical’ or ‘predictable’ whistleblower. Who whistleblows, why they do, why some chose one path and not the other, are not questions for which there are evidence-based answers (Bocchiaro, Zimbardo and Van Lange 2012). Searching for the individual traits and characteristics that constitute ‘the whistleblower’ overlooks the power and influence of the workplace context the whistleblower finds themselves in. Any search for individualized predictors of whistleblowing, devoid of attention to context, situation and power dynamics, is unlikely to produce anything other than a list of decontextualized, scientifically weak characteristics with little predictive or explanatory power. Personal and situational characteristics interact, but those contextual variables – the organization, its culture, relationships of power and authority, peer group pressures – explain the propensity to whistleblow more than individual factors (Near and Miceli 1996). If, for example, managers and supervisors routinely raise concerns (thus displaying prosocial organizational citizenship behaviour) the likelihood of a new employee doing so is greater, as they conform to the norms of the workplace and model their behaviour on more positionally powerful colleagues. Co-workers encourage or discourage whistleblowing through social reinforcement of workplace norms, and those informal structural characteristics of group behaviour tend to regulate member behaviour (Greenberger, Miceli and Cohen 1987). Thus whistleblowing becomes likely in organizations that actively support whistleblowing, in word and deed. These are the places with the ethics codes that lift off the page. They are likely to be high performing, relatively non-bureaucratic places, and cluster in the public rather than the private sector (Near and Miceli 1996). Norwegian public sector employees generally have a positive experience of whistleblowing, and many do so (Skivenes and Trygstad 2010). This isn’t surprising. Social behaviour does not occur in a vacuum.
WEIGHING UP THE PROS AND CONS OF WHISTLEBLOWING
To become a whistleblower in health and social care services, whatever the duties of the person’s professional code, requires a bit of thought. The whistleblower is raising concerns about something the organization is doing or not doing. The organization has its particular history, culture, climate and ways of managing dissent, which the whistleblower may well be very aware of. Weighing up whether or not to whistleblow becomes a sort of cost-benefit analysis (Miceli and Near 1985).
Whistleblowing involves other people, both in the organization and outside it (in health and social care, these include regulators, policy makers and politicians). The costs of not whistleblowing may well involve the perpetuation of harm, corruption and wrongdoing; the damage being done to people who are vulnerable, by virtue of their dependency on those health and social care services. The whistleblower’s own personal and professional circumstances – their livelihood, career history and aspirations, their obligations and responsibilities to support others – also figure on the costs side. On the other side is the benefit that exposing harm, poor practices and wrongdoing may bring to those directly affected by it. The organization may benefit from understanding better where, tacitly or knowingly, it colluded in the harm perpetrated. The deep learning on offer to the health or social care organization, which can come from disasters in health and social care, is a benefit beyond measure. But the organization has to engage, systemically and systematically, in that process of deep learning for that benefit to be realized.
CODES AND WOES
In the UK, registered health and social care professionals hold professional obligations not to permit people using their services to come to avoidable harm. These are variously expressed in professional codes of conduct and registration. Laying a mandatory duty on health and social care staff (discussed in Chapter 6) to report poor care typically decontextualizes incidents of poor care from the situational dynamics in which they occur. Registered nurses in the UK, for example, are required by their regulatory body to raise any concerns they might have about healthcare delivery. This requirement would seem to render redundant any consideration of the pros and cons of whistleblowing – they would have to do it, wouldn’t they? It seems not. Attree’s interviews with 142 nurses in England (age range 21–60; length of service two weeks to 40 years; ten males) highlighted the problems they felt they faced in doing something that wasn’t quite as simple as ‘just report it’. What put many of these nurses off reporting, contrary to the duty of their registration to raise concerns, were fears of personal repercussions and retribution, worries about being labelled a troublemaker or being blamed for causing difficulties for colleagues. Whistleblowing was regarded as a high-risk activity with little or no pay-off for the nurse (Attree 2007).
Of course, nurses in Attree’s interviews might have witnessed how those raising concerns before them had been treated. In England, the public inquiry into the failings of the Mid Staffordshire NHS Foundation Trust described the experiences of Nurse Donnelly who, in a protected disclosure under the UK’s whistleblowing legislation, said she had been asked to fabricate patient nursing notes to conceal the number of patients whose length of stay in the Accident and Emergency department of Stafford Hospital was breaching the four-hour waiting time target. That is, she had been asked to lie, to make it look as though some patient waits had not been in excess of four hours. Before she disclosed, she had sought advice from her Royal College of Nursing representative, who told her that there was little that could be done, and that she should just ‘keep her head down’ (Francis 2013a, p.109). In other words, do nothing.
Nurse Donnelly stood out from her peers in her decision to speak up about wrongdoing. She went against the grain of the organizational culture she worked in. In general, weighing up whether to report wrongdoing hinges, in part, on the whistleblower’s perceptions of the support or back-up they’ll get from their immediate manager if they do. Whistleblowing is more likely in organizations that support it, and which are themselves perceived to be fairer and ethical (Miceli and Near 2005). An employee may be more likely to report if they think their manager will back them up. By the same token, how the employee regards organizational whistleblowing policies influences their decision to whistleblow (Sims and Keenan 1998). Supervisor support for whistleblowing, and informal policies to support external whistleblowing, are significant predictors of whistleblowing. All of these are factors directly influenced by managers in the particular organizational culture and milieu: ‘…organization leaders create an environment of support and encouragement for their employees to speak up and blow the whistle on illegal, unethical, or illegitimate activities’ (Sims and Keenan 1998, p.420).
Key constituents of this ‘environment of support and encouragement’ to speak out are legal rights and protection, trade union support and communicative cultures in organizations where employees can freely voice opinion and criticism, and report wrongdoing, poor practice or corruption. In extensive studies on whistleblowing among public officials in Norway, Skivenes and Trygstad (2010) found that employees witnessing serious wrongdoing at work generally voiced their concerns and reported misconduct they observed to someone. Two-thirds of the 834 whistleblowers in this study said changes had come about as a result of their speaking out; eight out of ten reported they had had a positive response to their concerns. Employees were more likely to report misconduct if the person responsible was a subordinate or colleague, rather than an immediate supervisor or senior manager. Being a member of a trade union increased the likelihood of whistleblowing; and good contact with
