Exploring UK foundation doctors’ perceptions surrounding raising concerns in the workplace

Abstract

This study aims to explore the perceptions of foundation doctors (FDs) in the United Kingdom (UK) surrounding raising concerns in the workplace. An online survey was sent to all FDs in the UK between February and March 2018. Respondents were asked what they had observed or experienced that had been ethically challenging during their foundation training. The qualitative responses were coded into themes. Reasons why FDs wished to raise concerns in the workplace included disagreements about clinical decisions within the team, insufficient availability of resources, lack of senior colleague support and having to work beyond their competencies. Challenges faced by FDs when raising concerns included organisational resistance to change, difficulties in communicating ideas to those higher up in the hierarchy and the emotional stress of whistleblowing regarding senior colleagues.Perceived consequences of raising concerns included negative impact on FDs' reputation and career, and fear of bullying. To overcome these barriers, changes within organisations at all levels must take place in order to provide an environment where FDs are encouraged to raise concerns and thus make positive changes to their work environments for themselves, their colleagues and patients.

Organisational failure: rethinking whistleblowing for tomorrow’s doctors

“…Furthermore, despite a move towards incorporating systems-based approaches to issues of patient safety,11 learning continues to be muted by the ongoing emphasis within healthcare on individual action—both in the causes of poor patient care and in whistleblowing as a key response 13 25. This continued focus on individual action thereby overshadows learning around systems approaches.…”

“…Additionally, our analysis demonstrates the limitations of current whistleblowing practices, which again is dominated by an overly individualistic framing that continues to generate fear among both medical students 13 and junior doctors. 25 To redress this continued emphasis on the individual, and enhance the cohesion between the teaching of medical ethics and patient safety, we propose that medical educators for ethics and patient safety collaborate on the topic of whistleblowing to develop a curriculum that positions whistleblowing in its cultural and organisational context. Such a curriculum might use case studies to explore and identify the individual, collective and organisational factors that have enabled whistleblowing to be successful in raising concerns, and where they have obstructed or dismissed the raising of concerns.…”

“…They argue that whistleblowing has been portrayed too simplistically, as a choice to either speak up or stay quiet when the reality is a more complex process of verifying individual and collective understandings of risk, interactional ways of signalling concern, and multiple informal and formal routes of raising concerns 41. Emphasis to date has been on creating an environment where staff feel safe to raise concerns13 25 but in many healthcare inquiries there were whistleblowers; the obstacle was not unwillingness of staff to speak out but managerial unwillingness to hear and take action 41. Events at FGH were no exception.…”

“…However, many of these curricula reforms are short courses, delivered across either a single day22–24 or condensed period of time,20 with only one intervention spanning multiple years of medical training 21. Given how deeply entrenched perceptions are about the causes of healthcare failures—tending to be thought of as the consequence of error or incompetence—and the fear of raising concerns this continues to generate,13 25 current curricula interventions may not be sufficient to fully enable students to identify and appropriately respond to systemic threats to patient safety.…”

Balancing medical education with service in the workplace: a qualitative case study

“…However, despite the emphasis on clinical teaching, ward rounds often remain service driven, their educational value hindered by lack of time, noisy wards, patients not being available, reduced discussion time and an ever-increasing workload (Claridge 2011;Force, Thomas, and Buckley 2014;Talbot 2000;Bull, Mattick, and Postlethwaite 2013). It is clear then that there is a need for more research to explore the disconnection between service and education, and the resulting tensions that can develop in organisations (Cleland et al 2018;Teodorczuk et al 2018;Talash et al 2020). In this paper, we report on an intervention designed to overcome the perceived service/education tensions that can bring about this separation.…”