Whistleblowing is turning into one of those buzz words that just puts people in a bad mood. It is a word which is fast becoming overused and somewhat unfit for purpose. Those of us who work in hospitals realise that the best environment for listening to concerns and learning from error in a dynamic and timely way is one where nobody needs to employ the cacophonous screech of a whistle. Quiet words, routine conversations, an environment where all you need to raise a concern is the sound of your own voice; this is the goal.
Semantics aside, the role of whistleblowing guardian however is an important one. A role which, in the CQCs own words “will be responsible for leading local ambassadors across the country so that staff feel safe to raise concerns and confident that they will be heard” (1). A laudable aim, without doubt.
Last week, healthcare staff received some headline advice from our new whistleblowing guardian: “Happiness is the best medicine, grumpy doctors and nurses told” (The Times) “Grumpy doctors and nurses told to cheer up” (Daily Mail) “Grumpy doctors harm patients, whistleblowing chief says” (The Telegraph).
But does she have a point? Undoubtedly yes. That morale within the NHS is at a frightening ebb is abundantly clear. Trusts are concerned. In fact, the King’s Funds tells us the issue of staff morale constantly features in the top three of all concerns for financial directors, second only to delays in care and A&E waiting targets this quarter (2). In other quarters it has topped the pile.
The idea that ‘being happy’ will make things better isn’t at all far-fetched. Academics like Simone Barsade have long been telling us the importance mood has on team dynamics; some call it ‘the affective revolution’. In short, improving a team’s emotional culture improves performance and those of us in leadership positions have a greater effect on the group mood. Improving morale is the holy grail of retaining staff and of improving care. It is the only way for top down leadership to really empower change from the ground up.
But who’s job is it to say that, and more importantly how should it be said? I would argue not our whistleblowing guardian and certainly not through the type headlines we read last week.
Environments that support staff to speak up are ones in which they feel safe to do so. If you take a group of foundation doctors and ask them why they don’t feel comfortable discussing errors, they will tell you that they are worried about judgement. I know because I’ve asked them. In a survey of foundation trainees in my own trust, the top two barriers with overwhelming majority were ‘I don’t want to have a reputation for thinking I know better’ and ‘I am not perfect, so I don’t feel it is ok for me to point out other colleague’s errors’. This is not unique to my research; shame, embarrassment and fear of judgement are all common hurdles when it comes to developing platforms for learning from errors (3).
Our whistleblowing guardian says we need more ‘trust, joy and love’. She asks “wouldn’t it better if oxytocin was the predominant neurotransmitter in the NHS?”; I hear “wouldn’t it better if everyone just stiffened up their lip and plastered on a smile”. Intended or not, it is the implication and to the doctor or nurse struggling with the strain of working an understaffed rota or with the stress of seeing less than optimal care given to patients, what a worrying, demoralizing, deterring message that is.
Smile, it might never happen…..whistle a happy tune, no one will suspect you’re afraid.