At the second lecture in our 2013 leadership series, Michael Woodford held the audience's attention for 80 minutes with a gripping personal story about the importance of transparency and honesty. He shared his experience as the CEO of Olympus and of how he became a whistleblower when he uncovered accounting fraud on a massive scale.
He told a tale of cultures within cultures. It wasn't just the organisation's culture – hierarchical, deferential, based on consensus – that was an issue. The wider societal culture and other factors, including the media, auditors and regulators, also contributed to a reluctance to deal with the issue – an organisational culture doesn't sit in isolation. The Francis Report highlights the need for NHS organisations to create and maintain the right culture to deliver high-quality care that is responsive to patients' needs and preferences. Michael's story highlights the significant challenge of achieving this; it bring into sharp focus the scale of the task of helping NHS leaders to influence and change the complex cultures and sub-cultures that exist, and to make their teams, organisations and systems more care-centred. It reinforces the importance of those in the most senior roles in the NHS paying attention to and significantly shifting the NHS culture to encourage new and healthier micro cultures to be cultivated and grown.
The message from Michael was clear – the operating environment is created from the very top. He spoke of the Japanese culture being one of consensus and harmony, with loyalty as the core value, and how this took precedence over everything else. Loyalty to the organisation and to the chairman got in the way of honesty and transparency. There are parallels here to Francis's diagnosis that NHS leaders placed the highest value on prioritising financial balance and achieving targets while overlooking patient safety and the fundamental standards of care. At Mid Staffordshire, delivery on targets was rewarded, whereas messages about failures in standards of care were discouraged and ignored. This happened to such an extent that those further down the line came to treat finance and targets as ends in themselves. Under such a regime, leaders become detached from those on the front line and from the consequences of their decisions.
Michael used one interesting phrase: 'a lot of management is about turning the stones'. That sense of challenge and continuous enquiry is vital, not just for improving performance but also for uncovering problems. This is so pertinent to the role of non-executive directors on NHS boards and their duty of oversight and scrutiny. Francis identified that there had been a woeful lack of 'stone-turning' by the board at Mid Staffs. In order to learn from mistakes and identify areas for improvement, boards must learn to listen to what they hear, seek to understand, ask the difficult questions and encourage clinical staff to feel comfortable bringing bad news to their attention.
During his lecture, Michael made the case for independent whistleblowing hotlines and a ban on gagging orders. No doubt there are concrete things that organisations can put in place to facilitate the exposure of wrongdoing. But surely whistleblowing as an intervention is too late when it comes to ensuring high standards of patient care? Effort needs to be put into watching, spotting early warning signs and aiming for prevention. The longer-term goal needs to be creating cultures of openness, candour and honesty. This will not happen quickly or by accident, but will rely on strong and stable leadership reinforced by training, personal engagement and commitment.
Whistleblowing is one way of exposing the problem, but this does not necessarily solve the underlying issue. Leaders at all levels and of all disciplines will need to step up and take responsibility for changing a defective and destructive culture. Changing culture is hard work that requires vision, courage, energy and stamina. It will be easy to get distracted by the delivery and operational consequences of the most significant reforms ever faced by the NHS, but leaders ignore the task of culture shift at their peril. Breaking habits is hard and developing new ones requires practice and effort. Leaders leading culture change across the NHS will need to dig deep, cherish their values, look after themselves and stay focused on why things need to change. If they are successful, whistleblowing will be rare, not as a result of gagging clauses, but because the NHS has a thriving culture of transparency and honesty where decision-making is care-centred, and problems are surfaced early and resolved quickly.
Comments
"Every time whistleblowing is described as something different to raising concerns but as something which happens only when those concerns are ignored damages the concept of whistleblowing for good! Where leadership is good and concerns are listened to and acted on whoever blew the whistle can just get on with their work no stress no need to keep passing concerns up ladder etc. Whistleblowing is not just what is brought to the public attention; it is concerns raised by any employee who witnesses a problem (not only abuse etc.) and discloses it to their employer. A whistleblower is not just an employee who has not been listened to or suffered detriment from employer; to insist employees who raise concerns which happen to be acted on are anything other than whistleblowers is a way of somehow devaluing the act of raising concerns as though "whistleblowing" is a shameful act. A whistleblower is a right thinking employee who cares, raises concerns and who wants their employer to act in the public interest by listening and taking action! Good employers value employees who shine a light on problems by drawing them to their attention. Bad employers will act against any employee who raises concerns as cover up and reputation is more important than actually sorting out a culture which allows wrongdoing to persist. The latter causes whistleblowers to become newsworthy! The last thing a whistleblower wants is that. So please take on board a whistleblower in the news is no different from the whistleblower who's concerns were acted on appropriately they just had to keep disclosing higher and higher up the ladder until finally they may have had to go to regulators ombudsmen or even the media. Of course if treated so badly because they could not be silenced when concerns were not acted on they find themselves suspended and dismissed and have to try and find redress in the Employment Tribunal that is another way their actions become media news even if they had not gone to them before. We whistleblowers want action to be taken not notoriety!"
Thank you in advance.
Kind regards.
Vyv Wilkins Esq
Provided that concerns are not ad hominem (which need your accuser to face you, and not this mechanism), and are about 'dodgy diktats from on high', etc, I think the first requirement is to separate the person who pursues the issue with management/seniors, from the person who initially raises the concern (i.e, to stop people complaining both about and also to, their own boss). I think organisations/institutions need a network of 'Culture Champions', at least one per 'layer' (so a CC for ward nurses, a CC for ward managers, a CC for registrars, a CC for porters, a CC for middle managers, etc) to whom a person within that layer can take a concern. The CC then canvasses within the layer, to see if the concern has potential validity. Then the CC raises the issue with the appropriate CC within the layer where the solution might lay (these CCs would be linked by e-mail, etc, and would be a network), followed by discussions/etc, and either a solution, or the issue going to the Board.
Throw in that I would like the concerns raised, and the responses, to be 'public domain', and that is my solution, to this problem.
Would it work - no idea, unless it were tried !
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