What is it like to be a whistleblower in healthcare? What kind of ordeal do they undergo? What kind of life would they have after blowing the whistle? What do they get in return?
Whistleblowing is “an attempt by a member or former member of an organization to issue a warning to the public about a serious wrongdoing or danger created or concealed by the organization” (Ahern & McDonald, 2002; Bolsin, Faunce, & Oakley, 2005; Davis & Konishi, 2007) (source)
Simply put, whistleblowing is a reflection of the failure of an organization to address issues within its domain for the safety and welfare of patients or coworkers, that employees are compelled to take action outside the confines of an institution. It is pursuing the ethical call to uplift what is right and safe that reporting within organizations were not able to solve. In this article, we want to emphasize that whistleblowing is an event that occurs outside the institution.
In Hollywood, many whistleblower films made it to the list of top-grosser charts because of the life-changing, thrill-filled stories they spin. The clincher is that a whistleblower’s life makes a sharp turn after deciding to take on that role. The thing is, would the turn be for the worse or for the better?
In healthcare, the result remains to be seen. Perhaps if Hollywood producers looked into some of the stories of whistleblowers in healthcare, they would have everyone working on it, and reap a hefty profit after the film is released.
Let's take the Miofsky case in California as an example. Dr. Miofsky was an anesthesiologist, an experienced and well-respected physician in his field of practice. The whistleblower story starts when one OR nurse saw Dr. Miofsky taking weird pleasures rubbing his groin subtly on a 50-year old woman while her abdomen was open on the operating table. The OR nurse quickly told the chief OR nurse.
The nurses convened to put a stop to it, even conducting their own investigation. Their efforts to dig deeper led them to the discovery of the same perversion done on a 12-year old girl. The nurses made a three-page report to the hospital administrator, who did absolutely nothing. They decided to bring the case to court, where the nurse testified at the preliminary hearing that resulted in the prosecution of Dr. Miofsky on seven counts of perversion done on six patients.
We do not know what had happened to these nurses during and after the whole ordeal, but we are sure it wasn’t easy for any of them. Now, not all stories ended up like this.
There is another story of a young nurse whistleblower who reported a physician who orderedmassive dosage of medications on patients. One of that doctor's patients died. What was her life like during the pursuit of the case? The perpetrator's strong influence in the organization where they both belong soon took over. She found that her schedule changed every day, at times finding herself doing double shifts. One day on her way home after doing an 18-hour shift, her car's brakes failed. She had an accident that she luckily survived. Apparently, someone sabotaged her car.
Being a whistleblower is a decision some say only the courageous make. The repercussions are painful, and the results are unknown. Some win, some don’t. And the uncertainty of the result and the sure pain it brings are some reasons why healthcare employees don’t speak up. What are some other reasons why employees don’t speak up?
- Fear is one significant factor
The culture of fear tops it all. It may be fear of repercussions, and of retaliation by the ‘aggrieved' party. They fear to be the object of wrath. They don't want to get involved or get into trouble. Statistics states that 70% of healthcare workers would likely allow an error to occur because of such reasons.
- Employees do not want to be the bearer of bad news
- Social pressures exist. Employees think it is against the principle of teamwork.
- Difficulty working with authority gradients. They are ‘untouchable.'
- Due to the culture that dictates, ‘they know what they are doing.’
- Too much professional courtesy
- Lack of management support
- Lack of institutional policies on handling such cases
- Management is involved in the issue
- Lack of medium or process for reporting within the organization
- Disengaged employees don’t care as long as they get paid. They allow error to occur.
Now let us take a look at what happens when healthcare employees put on the ‘snitch’ coat. Medscape and Pubmed both published articles online citing adverse consequences of whistleblowing. Some of these are:
- Disappointment and disillusionment brought about by failure to solve the problem
- Isolation and ostracism
- Loss of employment
- Loss of credibility of one’s mental health
- Retaliatory acts from the accused
- Formal reprimand
- Highly stressful court proceedings
The road where justice and rectification wait in the end is never easy. But is whistleblowing morally required? Yes. For nurses, in particular, not speaking up when there is a need is a breach of the Nursing Code of Ethics. More importantly, whistleblowing is allowed when it is aligned with one's integrity, and in the values of honesty and courage.
On a manager's point of view, though, the issue of whistleblowing puts them also in a dilemma. Sometimes, turning a deaf ear and a blind eye is due to the perceived triviality or fears that a great worker in the person of the accused would be gone, or because escalation of the issue can damage the institution's reputation. The manager may be torn between acting on it, or just ignoring it while hoping it would die down in due time.
Though in a manager’s viewpoint, his inaction is justified, being passive is a taking a turn for the worse. Because the issue involves employees, performance gaps happen. Employee engagement is on the line. Patient safety is at stake.
Now, it is important to note, that it is at this stage, when the issue reaches the management, that it becomes the deciding point whether the case goes outside the organization or stays within. Remember that resolving issues within organizations contains the damages in all angles. It is, therefore, necessary to take steps to work on preventive measures before things get out of hand.
What can the management do as preemptive actions?
- Teach your employees to speak up and demonstrate attentive listening and to do so in the right channels. (ANA or the American Nurses Association has tips on how nurses can handle whistleblowing decisions)
- Establish a medium for reporting. Have an electronic but structured means of doing it because face-to-face reporting can be disconcerting especially to those at the frontline of service.
- Polish your guidelines and policies on reporting. Have these directives ready for access anytime. Consider an electronic knowledge hub that makes this feature or service searchable.
- Build a culture of transparency and feedback. This strategy is long-term but creates the best foundation to emphasize speaking up and reporting rather than whistleblowing.
There are ways to keep a healthy balance of the principles of teamwork, transparency, and ethics. We encourage speaking up. Being transparent gives voice to safety and ethics. This bridges performance gaps. It is time to evaluate your organization's status on reporting. It is in this area that ManageUp can help. Our lines are open to discuss these matters with you.