LIVING WITH PARADOX
The paradox of whistleblowing stretches much wider yet than a semantic ‘gag’ or ‘no gag’. From outside health and social care services, say from the perspective of the patient or user of one of those services, speaking out about bad practice or mistreatment of adults or children vulnerable through sickness or circumstance, is a no-brainer. Why would a trained professional, or any concerned observer, not raise their concerns? But then, when they do, why are there so few whistleblowers who, unequivocally, say they are glad they broke ranks to speak out, and that their disclosures were an excellent career move that they commend to others?
These paradoxes show up in UK public attitudes towards whistleblowing, and use of the term itself. A British survey of 2000 people found eight in ten believed it was more important to support, and not punish, people who blew the whistle. But fewer than half (47 per cent) thought British society found whistleblowing generally acceptable, or that managers were serious about protecting whistleblowers (Vandekerckhove 2012). Inevitably, and reflecting these conflicted attitudes, the word ‘whistleblowing’ itself attracts a negative valence, with the anodyne ‘raising concerns’ suggested as a preferable substitute to use with employees (OPCW 2012). Changing a word is one way of ducking the paradoxes. Another is to look at those conflicted contradictions head-on, and wonder what it is we do to people, organizations and health and social care, when we can’t name what is going on before us.
Individual and public reaction to whistleblowing and to the whistleblower are, then, riddled with paradox. These paradoxes conflict us all, whether whistleblower, bystander, or victim of wrongdoing. Culturally, certainly in the UK and the western world, the rugged individualist is venerated; but then of course we love the team player. Social pressures to fit in, coexist with those pushing us to stand out. The workplace demands that employees do things right; the public wants people who’ll do the right thing. Whistleblowers may be the butt of retaliation; yet their retaliators escape scrutiny. News, film, culture, love the lone ranger, yet loathe the oddball who wonders out loud if the emperor really is wearing any clothes. The whistleblower is feted, yet crushed; hailed as a hero, punished as a scapegoat.
SPEAKING OUT AS NOT BEING HEARD
Public reaction to the caricature of ‘care’ provided in some parts of the Mid Staffordshire NHS Foundation Trust in England between 2005 and 2009 was shock, dismay, distress. Yet many people working in those very services had raised concerns, only to find themselves ignored, marginalized, ostracized or scapegoated. Most simply gave up trying to get anything changed (Francis 2013a). In the face of this, few could take issue with the House of Commons Health Committee which, in its report on complaints and raising concerns in the NHS, said a ‘means must be found for health and care service workers to be able to speak up safely about professional concerns’. Still less, that ‘there is an unambiguous professional duty on professional registrants to speak up, but that equally there is a similar duty on employers to establish an open culture which encourages concerns to be raised and acts to address and resolve them, rather than punish the person raising them’ (HOC 2015, p.35). This Committee concluded that the detriment so many whistleblowers suffer has undermined public trust in the system’s ability to treat whistleblowers with fairness and, crucially (as if that were not enough), that this lack of confidence had implications for patient and citizen safety.
The paradox of all this is that whistleblowing is an act of loyalty, a commitment to doing right, to doing no more harm. That is prosocial behaviour, not deviance. The whistleblower’s ‘crime’ is their acting against the code of silence – that organizational omertà – which is, in dysfunctional organizational cultures, inexplicably conflated with loyalty. They may be vilified, typecast as a rat, snitch or ‘difficult’; as mentally ill, malicious or vengeful. (The particular slant of denigration varies.) Or, conversely, once the wrongdoing has been exposed to public opprobrium, they may enjoy 15 minutes of fame and be celebrated as a hero, before they turn to face the toll that speaking out has exacted on their future career prospects, personal relationships, and any possibility of financial security in what remains of their lives.
The more systematic the wrongdoing, the greater the reprisal. Speak out about wrongdoing that is widespread – the ‘new normal’ of the organization, say – and which involves a lot of cash, then those reprisals are likely to be whistleblower-crushing. Most whistleblowers don’t work in their employment field again. Some lose their homes, profession and health, to depression, alcoholism, family break-up. Still more, the greatest shock to the whistleblower is likely to be what they learn about the world in its reaction to their speaking out (Alford 2001).
These paradoxes lie at the heart of whistleblowing and they affect us all. That rugged, autonomous individual, so beloved of media or marketers, is quashed when the organization mobilizes its ‘vast resources in the service of the individual’s destruction’ (Alford 2001, pp.3–4). Alford, a psychoanalyst and political scientist, suggested we listen to that individual – the whistleblower – so that ‘we may learn something, not just about individuality, but about the forces that confront it’ (Alford 2001, p.4). This book sets out to contribute to that learning.
WHAT THIS BOOK IS ABOUT
This book starts from ‘the point’ (in both senses) of these paradoxes, that is, their location and their meaning. Its premiss is this: unless and until we wake up and face in to see these paradoxes at play in responses to whistleblowing, then the familiar, formulaic responses to shocking failures in health and social care – expensive public inquiries years after the event; retribution and silencing of those who spoke out, ‘tightening up’ of standards and targets that missed the point first time round, to name but some – will fail those who use those services, and those who speak out about problems in them. The irreplaceable public goods that are publicly-funded health and social care services are simply too precious to allow a systemic wilful blindness to these paradoxes, and their consequences, to prevail. Shining a light on those and on their systemic backcloth is what the whistleblower does and, in so doing, pays the price. Maybe it’s time for those who are elected to serve, lead, regulate and run those organizations to look, listen, and share that load a little.
Three distinct strands give shape to the book’s architecture. First is the significance of organizational culture and leadership in shaping the possibility that people will step up to speak out about poor practice. Organizational culture and its leadership (and that includes its political, policy and regulatory dimensions) can make or break the likelihood of whistleblowing, with or without further duties to report wrongdoing being imposed on professionals. Leadership (its style, culture and manner that are imprinted throughout the organization), and organizational culture, are interdependent, and – for better or for worse – overwhelmingly powerful influences on what happens in organizations, and to the whistleblower.
Organizational culture, with its norms, values, beliefs and behaviours is a dynamic, fluid, social construction. At any moment, people act in line with social norms, conventions and expectations (Warren 2003). The dynamics of working in teams – their power relations, group pressures to conform, to fit in, be a good team player – receive passing attention, at best, in a drive to pin blame on ‘someone’, occasionally on ‘something’, when things go wrong. Well-established findings on, for example, bystanders (why do people ignore somebody in pain?), silence (why do people keep quiet in the face of wrongdoing?), punishment (why do otherwise well-adjusted human beings inflict suffering on others when an authority tells them to do so?) and administrative evil (why do people not recognize that the bit part they may play in organizational life may contribute to larger destructive consequences?) receive little explicit attention. What are these saying about the organization’s response to the whistleblower or to the concerns they raise?
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