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
inhibited/promoted
raising concerns in the
health and social care
workplace.
Background: organizational failure and
silence
• 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
behaviour
• Were employees encouraged to raise
concerns?
• 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
interventions
Workplace
“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
space.
• 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
2008).
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
documentation?
• 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
my…..mother/brother/grandparent”
The way forward – right-touch
regulation
• 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
press)
• 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.
• jonesa97@cardiff.ac.uk