Factors influencing nurses? decisions to raise concerns about care quality

Abstract

Disincentives to reporting need to be addressed if an open culture, which promotes quality, safety and learning, is to be developed. Findings give cause for concern and indicate a need to review organizational and professional guidelines, and organizational reporting systems.

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"

“…Research into the reasons why healthcare professionals, in this case nurses, are reluctant to report malpractice have been linked to both apathy, tied to an assumption that no action will be taken, and fear of retribution to their professional standing or personal lives, which have included both negative physical and emotional affects. 27,30,[32][33][34] In a recent UK National Health Service (NHS) survey of more than 2000 managers and clinicians a disparity of opinion emerged on the 'culture of voice. ' Here, staff were invited to report on the quality of leadership, transparency, and whistleblowing.…”

“…Personal and professional retaliation against whistleblowers has been wellrecognised and involves damaging processes that attempt to deal with the disclosure by discrediting the whistleblower rather than dealing with the information disclosed. [24][25][26][27][28][29][30][31] Mannion and Davies 1 like others have posed the argument that whistleblowing need not occur if those responsible in an organisations respond positively to concerns raised and begin a process of learning from mistakes as well as implementing effective policies to prevent future harm. However, to achieve this there needs to be a recognition that a culture of silence will remain in health services if the following dual processes continue to occur when staff raise concerns internally.…”

Exploring Healthcare Professionals' Use of Narrative Mediation Approaches to Address Disclosure and Apology in the Aftermath of Medical Errors

“…The hierarchical culture itself is a barrier to disclosure and apology. For example, there is strong evidence that nurses who are trained to speak up when things are going wrong, also learn from the hierarchical top down culture to take a subordinate position when things become stressful (Attree, 2007). Decisions about what actions a doctor or nurse will make in response to error are ultimately shaped by discursive options and the positions offered by the background cultural terrain that exists in the health care environment.…”

Patient and Family Involvement: A Discussion of Co-Led Redesign of Healthcare Services (Preprint)

“…Another factor found to impede meaningful patient involvement is organizational and professional resistance to change or learning something from health service providers [42]. Evidence suggests that a blame culture within health care organizations prevents staff from being open and sharing their views [43][44][45][46]. Managerial interest is often focused on budgets and targets and achieving status rather than on patients and their families.…”