“Supporting nursing, midwifery and allied health professional students to raise concerns with the quality of care: A review of the research literature”

Milligan, Frank; Wareing, Mark; Preston‐Shoot, Michael; Pappas, Yannis; Randhawa, Gurch; Bhandol, Janine

doi:10.1016/j.nedt.2017.06.006

Cited by 26 publications

(23 citation statements)

References 25 publications

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“…It stressed the Francis themes of 'openness, transparency and candour' (p. 22), and supported Francis' recommendation on 'gagging clauses' (© Crown copyright. Contains public sector information licensed under the Open Government Licence v3.0).…”

Section: Secretary Of State For Health (Mid Staffordshire Nhs Foundatmentioning

confidence: 87%

“…125 Milligan et al, 22 drawing on research by Espin and Meikle 94 with health-care students, note that some of the barriers created by senior managers could be overcome by creating a more clearly defined 'reporting ladder' (p. 27) that facilitates the recognition of a clear path through which concerns could be raised in organisations.…”

Section: Leadership and Managementmentioning

confidence: 99%

“…Although this methodology generated a strong general academic literature, it was recognised that some more recent empirical health-care research papers may not be found using this route. In recognition of this, the papers from the bibliographies of three recent literature reviews in related fields (Milligan et al, 22 Okuyama et al 21 and Kelly and Jones 19 ) were converted into an 'empirical health care' bibliography ( Figure 4). Papers were selected based on an academic judgement of their relevance to this report.…”

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confidence: 99%

“…Bibliographies from Milligan et al, 22 Okuyama et al 21 and Kelly and Jones, 19 each of whom had previously reviewed literature relating to whistleblowing in health care, resulted in 113, 27 and 53 (respectively) potential references being identified, making 193 in total…”

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confidence: 99%

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Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews

Mannion

Blenkinsopp

Powell

et al. 2018

Health Serv Deliv Res

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Background There is compelling evidence to suggest that some (or even many) NHS staff feel unable to speak up, and that even when they do, their organisation may respond inappropriately. Objectives The specific project objectives were (1) to explore the academic and grey literature on whistleblowing and related concepts, identifying the key theoretical frameworks that can inform an understanding of whistleblowing; (2) to synthesise the empirical evidence about the processes that facilitate or impede employees raising concerns; (3) to examine the legal framework(s) underpinning whistleblowing; (4) to distil the lessons for whistleblowing policies from the findings of Inquiries into failings of NHS care; (5) to ascertain the views of stakeholders about the development of whistleblowing policies; and (6) to develop practical guidance for future policy-making in this area. Methods The study comprised four distinct but interlocking strands: (1) a series of narrative literature reviews, (2) an analysis of the legal issues related to whistleblowing, (3) a review of formal Inquiries related to previous failings of NHS care and (4) interviews with key informants. Results Policy prescriptions often conceive the issue of raising concerns as a simple choice between deciding to ‘blow the whistle’ and remaining silent. Yet research suggests that health-care professionals may raise concerns internally within the organisation in more informal ways before utilising whistleblowing processes. Potential areas for development here include the oversight of whistleblowing from an independent agency; early-stage protection for whistleblowers; an examination of the role of incentives in encouraging whistleblowing; and improvements to criminal law to protect whistleblowers. Perhaps surprisingly, there is little discussion of, or recommendations concerning, whistleblowing across the previous NHS Inquiry reports. Limitations Although every effort was made to capture all relevant papers and documents in the various reviews using comprehensive search strategies, some may have been missed as indexing in this area is challenging. We interviewed only a small number of people in the key informant interviews, and our findings may have been different if we had included a larger sample or informants with different roles and responsibilities. Conclusions Current policy prescriptions that seek to develop better whistleblowing policies and nurture open reporting cultures are in need of more evidence. Although we set out a wide range of issues, it is beyond our remit to convert these concerns into specific recommendations: that is a process that needs to be led from elsewhere, and in partnership with the service. There is also still much to learn regarding this important area of health policy, and we have highlighted a number of important gaps in knowledge that are in need of more sustained research. Future work A key area for future research is to explore whistleblowing as an unfolding, situated and interactional process and not just a one-off act by an identifiable whistleblower. In particular, we need more evidence and insights into the tendency for senior managers not to hear, accept or act on concerns about care raised by employees. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Section: Secretary Of State For Health (Mid Staffordshire Nhs Foundatmentioning

confidence: 87%

Section: Leadership and Managementmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews

Mannion

Blenkinsopp

Powell

et al. 2018

Health Serv Deliv Res

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“…Numerous researchers and commentators have examined this topic. Jackson et al () reviewed the empirical work which explores the responses of registered nurses to poor practice, with Milligan et al (), Ion et al (), Bickhoff, Levett‐Jones, and Sinclair () and Fagan, Parker, and Jackson () undertaking similar work in relation to nursing students. They reach the same general conclusions.…”

Section: Reporting Poor Care: How Do Witnesses Respond?mentioning

confidence: 99%

Failure to report poor care as a breach of moral and professional expectation

Ion

Olivier

Darbyshire³

2019

Nursing Inquiry

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Cases of poor care have been documented across the world. Contrary to professional requirements, evidence indicates that these sometimes go unaddressed. For patients, the outcomes of this inaction are invariably negative. Previous work has either focused on why poor care occurs and what might be done to prevent it, or on the reasons why those who are witness to it find it difficult to raise their concerns. Here, we build on this work but specifically foreground the responsibilities of registrants and students who witness poor care. Acknowledging the challenges associated with raising concerns, we make the case that failure to address poor care is a breach of moral expectation, professional requirement and, sometimes, legal frameworks. We argue that reporting will be more likely to take place if those who wish to enter the profession have a realistic view of the challenges they may encounter. When nurses are provided with robust and applied education on ethics, when “real‐world” cases and exemplars are used in practice and when steps are taken to develop and encourage individual moral courage, we may begin to see positive change. Ultimately however, significant change is only likely to take place where practice cultures invite and welcome feedback, promote critical reflection, and where strong, clear leadership support is shown by those in positions of influence across organisations.

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A behavioural study of obedience in health professional students

Violato

Witschen

Violato

et al. 2021

Adv in Health Sci Educ

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Interprofessional Education and Collaborative Practice (IPECP) is a field of study suggested to improve team functioning and patient safety. However, even interprofessional teams are susceptible to group pressures which may inhibit speaking up (positive deviance). Obedience is one group pressure that can inhibit positive deviance leading to negative patient outcomes. To examine the influence of obedience to authority in an interprofessional setting, an experimental simulated clinical scenario was conducted with Respiratory Therapy (RT) (n = 40) and Advanced Care Paramedic (ACP) (n = 20) students. In an airway management scenario, it was necessary for students to challenge an authority, a senior anesthesiologist, to prevent patient harm. In a 2 × 2 design cognitive load and an interventional writing task designed to increase positive deviance were tested. The effect of individual characteristics, including Moral Foundations, and displacement of responsibility were also examined. There was a significant effect for profession and cognitive load: RT students demonstrated lower levels of positive deviance in the low cognitive load scenario than students in other conditions. The writing task did not have a significant effect on RT or ACP students’ behaviour. The influence of Moral Foundations differed from expectations, In Group Loyalty was selected as a negative predictor of positive deviance while Respect for Authority was not. Displacement of responsibility was influential for some participants thought not for all. Other individual variables were identified for further investigation. Observational analysis of the simulation videos was conducted to obtain further insight into student behaviour in a compliance scenario. Individual differences, including experience, should be considered when providing education and training for positive deviance. Simulation provides an ideal setting to use compliance scenarios to train for positive deviance and for experimentation to study interprofessional team behaviour.

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“Supporting nursing, midwifery and allied health professional students to raise concerns with the quality of care: A review of the research literature”

Cited by 26 publications

References 25 publications

Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews

Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews

Failure to report poor care as a breach of moral and professional expectation

A behavioural study of obedience in health professional students

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