Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations

Abstract

Abstract'Whistleblowing' has come to increased prominence in many health systems as a means of identifying and addressing quality and safety issues. But whistleblowing -and the reactions to it -have many complex and ambiguous aspects that need to be considered as part of the broader (organisational) cultural dynamics of healthcare institutions.

Whistleblowing Need not Occur if Internal Voices Are Heard: From Deaf Effect to Hearer Courage Comment on "Cultures of Silence and Cultures of Voice: The Role of Whistleblowing in Healthcare Organisations"

“…In order to avoid negative feedback there was a demonstrated tendency to distance themselves from frontline staff, in addition concerns raised or critical comments were perceived as merely as 'whining or disruptive behaviour. ' 37 What is clear is that the 'deaf affect' to internal reporting is certainly prevalent in healthcare and as speculated by Mannion 1 are correct in their call for a strategy to deal with the resistance to bad news by those in a position of power. However, this should be considered as part of an overall strategy to improve patient safety and clinical governance and not framed as whistleblowing strategy.…”

A Wicked Problem? Whistleblowing in Healthcare Organisations Comment on "Cultures of Silence And Cultures of Voice: The Role Of Whistleblowing in Healthcare Organisations"

“…1 Wildavsky noted the shifting terrain in which policy is made and analysed as he emphasised how answers change rapidly and regularly to questions about what constitutes truth and who holds power? This shifting terrain applies equally to ideas about patient safety and care quality.…”

“…In all likelihood, most organisational activities serve some sort of goal and when those goals are competing or when they represent different interests, gaining a balance between moral, ethical and business concerns require the sort of sophisticated examination recommended by Mannion and Davies. 1 For example, when health workers serve business goals and strive for efficiency they may have to sacrifice some aspects of care quality. At the extreme, aspects of care may be redefined as falling outside the remit of the organisation -the question is more about which goal is prioritised; what is more important -patient safety, care quality or remaining financially viable?…”

Whistleblowing in the Wind Towards a Socially Situated Research Agenda: A Response to Recent Commentaries

“…Hyde argues that for a fuller understanding of whistleblowing we also need to understand how well-meaning workers might come to commit harm on behalf of the organisation, and such notions speak to our own observations about the ambiguity of whistleblowers and the actions about which they speak. 1 Continuing a recurrent theme across the commentaries, Aled Jones 6 cites examples from the United States and Norway that suggest that workplace environments that value employee whistleblowing and voice are both possible and effective. The examples provided demonstrate a preoccupation with constantly monitoring systems of reporting and responding, ensuring that these are focused on learning and system improvement.…”