More than 300 National Health Service (NHS) and care workers have died from COVID-19 during the pandemic, but it is not just lives at risk. Their livelihoods are on the line too, with many warned they could lose their jobs if they speak out about the shortages of PPE for frontline workers.
In fact, whistleblowing and the global crisis caused by COVID-19 are closely intertwined. We first learned about the outbreak and its seriousness through whistleblower Dr Li Wenliang, who was detained by Chinese authorities when he raised the alarm in early January and who has since fallen victim to the virus.
Many other doctors have since been silenced after speaking out to protect lives. Dr Ming Lin was fired from his job in the emergency room at St Joseph Medical Centre in Washington State at the end of March for highlighting the lack of protective measures for staff and patients. Meanwhile, doctors in Pakistan were jailed for demanding PPE.
In the UK, 10,000 NHS staff signed a letter to the Prime Minister demanding better protection against COVID-19. It described how doctors and nurses who spoke out had been threatened with dismissal. This has left hospitals vulnerable to the dreaded surge that threatens ICU units as COVID-19 spreads.
The barriers preventing healthcare staff from speaking out pre-date COVID-19.
Healthcare is typically hierarchical. Its large, public sector organisations can tend towards an authoritarian, top-down style of leadership, keeping managers apart from those lower down. This separation may help with the co-ordination of complex activities, but it often means managers are less open to challenge from staff.
Senior leaders are often seen as unapproachable. Nurses rarely criticise senior doctors’ decisions, even those that are potentially dangerous. This can give rise to a ‘deaf effect’, which happens when a healthcare manager does not hear, ignores or overrules a report of bad news. Successive surveys show healthcare workers do not speak out in this sector because they believe it will be futile.
Healthcare managers may act defensively as the sector is subject to greater levels of media scrutiny. The public tends to be intolerant of mistakes, despite the fact that healthcare is inherently complex and errors are a fact of life. Crises frequently result in a search to blame and punish individuals.
Because scandals are so public, and because health is traditionally highly political, managers tend to be rewarded for success stories, but punished when problems reach the public domain. It is almost impossible to manage effectively with this kind of pressure. There is a strong temptation to suppress problems at the early stage, in the hope of moving to a new role before things get out of hand.
This emphasis on delivering good news can lead to ‘comfort seeking’ in response to serious problems. Managers limit their sources of information when investigating, focusing on data that reassures them ‘all is well’. Negative messages from frontline staff are ignored. Whistleblowers are typically seen as an obstacle to be removed, rather than a valuable source of insight, creating a fear of reprisals.
Staffing arrangements can also discourage healthcare workers from speaking out. Research shows those in relatively secure management roles are most likely to disclose unsafe care as they are more experienced and enjoy more protection from reprisals.
However, this kind of employee is becoming less common. Since the 1980s, we have seen an increase in staff on short-term contracts in place of permanent employees. They are understandably much less likely to disclose serious issues. Junior doctors, students, trainees and agency workers may remain silent if they encounter wrongdoing, because they are fearful for their jobs. They depend on references and approval from their line managers for future job security. Nursing home staff and home carers are often in an equally precarious position.
The cultural and structural barriers to staff raising concerns mean nurses and doctors often act independently to deal with extreme incidents of poor care, finding 'work-arounds', rather than making formal complaints. This strategy helps clinicians deal with isolated incidents. But COVID-19 is not an isolated incident and the serious issues facing healthcare staff cannot always be ‘worked around’.
If reporting problems was difficult before COVID-19 began, it is almost impossible now. Whistleblowers’ disclosures can help prevent major disasters by disclosing serious problems which will otherwise go unreported, but this needs transparent channels for reporting wrongdoing.
Senior healthcare managers, politicians, and unions must not ignore voices of frontline healthcare staff who struggle to draw attention to serious issues they encounter at work.
Much more has to be done by our employers and governments, not only to support whistleblowers who have brought crucial information to public attention, but also to stop persecuting and harassing these courageous individuals and their supporters. For this to happen whistleblowing has to be normalised for the public as well, as a citizen duty rather than a heroic and risky endeavour.
This article has been adapted from a blog for Centre for Health and Public Interest.
Vandekerckhove, W., Fotaki, M. and Kenny, K. (2016) "Effective speak-up arrangements for whistle-blowers : a multi-case study on the role of responsiveness, trust and culture".
Kenny, K., Vandekerckhove, W. and Fotaki, M. (2019) "The whistleblowing guide : speak-up arrangements, challenges and best practices", John Wiley & Sons, Inc, Hoboken, New Jersey, US.
Kenny, K., Fotaki, M. and Vandekherckove, W. (2020) "Whistleblower subjectivities : organization and passionate attachment", Organization Studies, 41, 3, 323-343.
Marianna Fotaki is Professor of Business Ethics and teaches Governance and Corporate Responsibility on the suite of MSc Business courses plus Strategic Leadership and Ethics on MSc Marketing & Strategy. She also lectures on Ethical Issues & Social Responsibility in Contemporary Business on the Undergraduate programme.
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