Presentation on theme: "Workplace initiatives and employees’ views about whistle- blowing and raising concerns in health and social care. Dr Aled Jones & Prof Danny Kelly School."— Presentation transcript:
Workplace initiatives and employees’ views about whistle- blowing and raising concerns in health and social care. Dr Aled Jones & Prof Danny Kelly School of Healthcare Sciences, Cardiff University
The study Commissioned and undertaken on behalf of the Older People’s Commissioner for Wales. Exploring factors which inhibited/promoted raising concerns in the health and social care workplace.
Background: organizational failure and silence Healthcare literature often suggests that when organizations “unexpectedly” fail employees remain “silent” Silence is the “dominant response within many organisations” (Morrison and Milliken 2000: 707) “Cultures of silence exist” within healthcare (Moore and McAuliffe 2012: 333).
An alternative view…… Catastrophic organizational failure is rarely “unexpected” event for employees. Organizations are often “noisy” and full of “chatter” related to “staff concerns” A period of time exists when emerging problems can be detected; “incubation periods” (Turner 1976, Vaughan 1990) exist. Evidence – every public inquiry into health failure since 1967; sociology of disaster literature.
The study 60 interviews (individual & focus group) Participants recruited from hospitals, nursing homes, residential care, domiciliary care. Included: Managers, staff nurses, care assistants, physiotherapists, ancillary workers (Cleaners, kitchen staff), student nurses.
Managing the workforce & workplace behaviour Were employees encouraged to raise concerns? Managerial interventions existed on a ward or team level – creating spaces/opportunities for employees to raise issues and concerns Which counter-balanced: Norms/behaviours which suppresses employee concerns being raised.
Management interventions Workplace Regulators Workplace norms Team culture Fear Induction Team meetings “Open door” culture
“Management” information generating and seeking interventions Range of “socio-material” interventions at a ward or team level. Staff induction communicated that that continual feedback/interaction is an expectation and prosocial behaviour. Team meetings arranged - fixed/open agenda. “Open door policy” – creates/signals interactional space. Suggestion/feedback boxes – issues then discussed at meetings.
Open door and team meetings as “information ground” Creating an information sharing space (“information ground”) in team meetings for staff to vent their feelings and gain mutual support. Useful as there has been a demise of informal information grounds such as the morning tea break ritual, staff rooms, doctors’ mess….etc Which historically provided time, space and a workplace environment for front-line nurses, doctors and other care workers (Lee 2001; Nettleton et al 2008). Lee, D. (2001) The morning tea break ritual: a case study, International Journal of Nursing Practice, 7, 2, 69–73 Nettleton S et al (2008) Regulating medical bodies? The consequences of the modernisation of the NHS and the disembodiement of clinical knowledge. Soc Health and Illness 30:2
Formative spaces They combine support and challenge in a high trust environment, which is backed by a strong professional ethos and in which participants feel safe enough to bring personal and professional dimensions together (McGivern et al 2009).
Information grounds and spaces – any role for regulation? Should informal information sharing spaces and opportunities be regulated for and the data captured e.g. through statutory supervision? Statutory Supervision of Midwives – ineffective in Morecambe Bay. Consultation around regulation of nurses – the need for mandatory supervision and documentation? How do practitioners view regulators?
Regulators – practitioners view Disproportionate - “Heavy handed”; “Over- reaction”; ineffective when needed. Codes of conduct limited or no use as a resource for practitioners. Heightened practitioners awareness of need for defensive practices - “protect yourself first” Alternatively - personal ethics – frequently provided a “reaction point” …..”if that was my…..mother/brother/grandparent”
The way forward – right-touch regulation Right-touch regulation recognises that there is usually more than one way to solve a problem and that regulation is not always the best answer. It may be more proportionate, for instance, to promote greater cooperation and sharing of good practice. Professional and personal practice
Jones A and Kelly D (2014) Whistle-blwoing and workplace culture in older peoples’ care: qualitative insights from the health and social care workforce. Sociology of Health & Illness (in press) Kelly, D. M. and Jones, A. (2014) When care is needed: The role of whistle blowing in promoting best standards from an individual and organisational perspective. Quality in Ageing (in press)
Thanks to those who participated in the study. Ann Gallagher (Surrey Uni), Tricia Brown (Cardiff Uni), for contributing to final report and being “critical friends” to the project. The Study Advisory group Older People’s Commissioner for Wales for funding the study. firstname.lastname@example.org