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.
This whistleblowing issue is much discussed over on the Nursing Times website, because in bad hospitals, managers 'bully' clinicians who raise concerns.
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.
Hi I am reviewing our Trust whistleblowing policy. I would be grateful fro any copies of up to date policies fit for purpose taking onto account Francis report recommendations etc.
being on a reception desk surrounding by patients and then told as you didnt help one patient out your been sent to a panel for racial discrimination even when you cannot see the patient who is sitting on the floor in the corner out of view and you are helping out others in front of you. the nhs is a joke, HR teams dont support you and feel sucidial.
vyv Wilkins by now I expect you will have a Whistleblowing policy in place. All I can suggest is you have in place a way of policing whether it is being followed by your different departments. However robust the policy if management fail to follow it's procedures individual employees who wish to raise a concern wills not feel safe doing so. Hopefully your policy was put in place to help problems to come to light so action can be taken to nip them in the bud; not just as a sop to regulators ombudsman etc. as proof that you encourage employees to speak up when in actual fact every effort is made to silence the whistleblower. My LA had a robust policy but find excuses not to follow it and concerns raised are not recorded as a whistleblowing event which looks good in annual reports. The whistleblowers become a liability as they continue to raise concerns which have not been acted on properly so suspensions and disciplinary action is taken to silence them or they can just be moved to another work area which may silence them as they may not realise no action was taken regarding the concern raised. The culture of not wanting to listen to concerns raised by employees usually comes down from the top of the organisation. I hope this is not the case in your organisation.
Reading this in Nicola Hartely's piece "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." begs the question why this need to put the act of whistleblowing on a different plain? Higher management will not be aware of problems down at the coalface in an organisation if those working on the front line do not raise concerns (whistleblow) as certain management cultures are adept at keeping problems under wraps. Hence the immediate defamation of anyone who has the temerity to raise a concern. Leaderships who fear loss of reputation if problems are acknowledged Of course when leadership is weak, ineffectual and prefers to turn a blind eye believing to take action would be having to admit there is a problem an employee who discloses concerns becomes a dangerous, unwanted individual and will have to be silenced one way or another. There is always a whistleblowing policy in place nowadays so why not use it and forget rubbish about "But surely whistleblowing as an intervention is too late when it comes to ensuring high standards of patient care?" as only an employee will raise concern when things are going wrong as most likely managers would have been turning a blind eye afraid themselves to rock the boat or even instrumental in the problem. Below is another comment I made regarding this unnessesary distaste and misunderstanding of the act of whistleblowing:-
"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!"
I haven't been dismissed yet, but I did whistleblow (raise concerns) all post the Sir Robert Francis enquiry and the introduction of a number of initiatives to bring about a more open, transparent and candid culture (they haven't - not least from my experience and those I am reading of others) which all gave me a false sense of security, as I now know - Jennifer who wrote the previous article puts it so well, whilst its the right thing to do, it is not received that way, even when internal processes and discussions are suggesting otherwise. I currently await my fate
Comments
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 !
Thank you in advance.
Kind regards.
Vyv Wilkins Esq
"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!"
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