ALED JONES, CARDIFF - Professional Standards Authority

Workplace initiatives and
employees’ views about whistleblowing and raising concerns in
health and social care.
Dr Aled Jones & Prof Danny Kelly
School of Healthcare Sciences,
Cardiff University
The study
Commissioned and
undertaken on behalf of
the Older People’s
Commissioner for Wales.
Exploring factors which
raising concerns in the
health and social care
Background: organizational failure and
• Healthcare literature often suggests
that when organizations
“unexpectedly” fail employees
remain “silent”
• Silence is the “dominant response
within many organisations”
(Morrison and Milliken 2000: 707)
• “Cultures of silence exist” within
healthcare (Moore and McAuliffe
2012: 333).
An alternative view……
• Catastrophic organizational failure is rarely
“unexpected” event for employees.
• Organizations are often “noisy” and full of
“chatter” related to “staff concerns”
• A period of time exists when emerging problems
can be detected; “incubation periods” (Turner
1976, Vaughan 1990) exist.
• Evidence – every public inquiry into health failure
since 1967; sociology of disaster literature.
The study
• 60 interviews (individual & focus group)
• Participants recruited from hospitals, nursing homes,
residential care, domiciliary care.
• Included: Managers, staff nurses, care assistants,
physiotherapists, ancillary workers (Cleaners, kitchen
staff), student nurses.
Managing the workforce & workplace
• Were employees encouraged to raise
• Managerial interventions existed on a ward or
team level – creating spaces/opportunities for
employees to raise issues and concerns
• Which counter-balanced:
• Norms/behaviours which suppresses
employee concerns being raised.
“Management” information
generating and seeking interventions
• Range of “socio-material” interventions at a ward
or team level.
• Staff induction communicated that that continual
feedback/interaction is an expectation and
prosocial behaviour.
• Team meetings arranged - fixed/open agenda.
• “Open door policy” – creates/signals interactional
• Suggestion/feedback boxes – issues then
discussed at meetings.
Open door and team meetings as
“information ground”
• Creating an information sharing space (“information
ground”) in team meetings for staff to vent their
feelings and gain mutual support.
• Useful as there has been a demise of informal
information grounds such as the morning tea break
ritual, staff rooms, doctors’ mess….etc
• Which historically provided time, space and a
workplace environment for front-line nurses, doctors
and other care workers (Lee 2001; Nettleton et al
Lee, D. (2001) The morning tea break ritual: a case study, International Journal of Nursing Practice, 7, 2, 69–73
Nettleton S et al (2008) Regulating medical bodies? The consequences of the modernisation of the NHS and the
disembodiement of clinical knowledge. Soc Health and Illness 30:2
Formative spaces
• They combine support and challenge in a high
trust environment, which is backed by a strong
professional ethos and in which participants
feel safe enough to bring personal and
professional dimensions together (McGivern
et al 2009).
Information grounds and spaces – any
role for regulation?
• Should informal information sharing spaces and
opportunities be regulated for and the data
captured e.g. through statutory supervision?
• Statutory Supervision of Midwives – ineffective in
Morecambe Bay.
• Consultation around regulation of nurses – the
need for mandatory supervision and
• How do practitioners view regulators?
Regulators – practitioners view
• Disproportionate - “Heavy handed”; “Overreaction”; ineffective when needed.
• Codes of conduct limited or no use as a resource
for practitioners.
• Heightened practitioners awareness of need for
defensive practices - “protect yourself first”
• Alternatively - personal ethics – frequently
provided a “reaction point” …..”if that was
The way forward – right-touch
• Right-touch regulation recognises that there is
usually more than one way to solve a problem
and that regulation is not always the best
answer. It may be more proportionate, for
instance, to promote greater cooperation and
sharing of good practice.
• Professional and personal practice
Jones A and Kelly D (2014) Whistle-blwoing and
workplace culture in older peoples’ care:
qualitative insights from the health and social care
workforce. Sociology of Health & Illness (in press)
Kelly, D. M. and Jones, A. (2014) When care is
needed: The role of whistle blowing in promoting
best standards from an individual and
organisational perspective. Quality in Ageing (in
• Thanks to those who participated in the study.
• Ann Gallagher (Surrey Uni), Tricia Brown (Cardiff
Uni), for contributing to final report and being
“critical friends” to the project.
• The Study Advisory group
• Older People’s Commissioner for Wales for
funding the study.
• [email protected]