Physicians, heal yourselves…

…I once suggested to a Doctor that the National Health Service should name and shame those employers who treat their staff poorly because dealing with the stress and depression of their ill employees is costing UK taxpayers a fortune and diverting scarce resources from dealing with other issues; that would be fine they said, if the worst offender wasn’t the NHS itself. This week has seen the launch of a report (yawn, another document) into the treatment of whistleblowers in the NHS, the findings were not good and for those of us that work in the NHS we’d all have been surprised if they were.

Whistle (cropped)But whistleblowing is a funny old term isn’t it, the very history of the word and the connotations around it suggest that the act itself is something out the ordinary, a going against of the natural order, like snitching on your friends or grassing up your colleagues. But whistleblowing is of course the very simple process of discovering something, often by accident, something that isn’t serving the needs of patients or service users well and then trying to get it fixed. Of course in large parts of the Private Sector they call the discovering, unearthing and subsequent fixing of things that don’t serve the customers well, “marketing” or “continuous improvement”…it would seem strangely illogical and counter-intuitive that those tasked with delivering quality services to a taxpaying public that relies on them and funds them, would not want to know if something was amiss with the services they were delivering? After all, if you don’t know what is amiss you are by definition ill-equipped to prioritize and direct your resources…if the tiles are coming off the roof then you should probably put off cleaning the kitchen windows; you get the idea.

In his book the Fifth Discipline, Peter Senge makes the point that it is not that organisations are incapable of fixing their problems, it is more often that they simply don’t know that they have them; they are quite literally blind to them. Again, this observation would suggest that the findings of “objective analysts”, “value adders”, or “truth tellers” as we might relabel whistleblowers, would be of great importance to any organisation that genuinely wanted to meet the needs of its service users?

Margaret Heffernan suggests that some organisations may actually develop a deliberate willful blindness to stop them seeing whatever harm it is that they may be doing, intentionally or otherwise…this tendency is of course more naturally prevalent in the Public Sector due to the absence of competition and the presence of regulators who can effectively be “duped” much more easily than the marketplace; this statement is not a cry for privatization, simply an observation about how regulatory regimes produce perverse incentives. These regimes and their accompanying targets were designed to produce the customer centric behaviors that the linear relationship between the state of an organisations balance sheet and success as defined by its customers generally achieves in the Private Sector; but because the relationship between the balance sheet and the customer (service user or patient) is indirect in the Public Sector, the game becomes one in which the regulator is viewed as the real customer; kept happy at all costs and served with minion like servility. We all know it so lets acknowledge it.

Peter Drucker observed that in his role as a bystander he would often act as a prism that helped organisations receive an alternative view to that which was generally contained in the corporate report…of course he also acknowledged that his view was not always welcome. He seems to have been fully aware that he ran the risk of shocking people but he also recognized that the view of the objective bystander was unique and valuable.

Apparently, when a worker at Toyota notices a problem, they have the freedom to stop the line and to make sure the problem is fixed before restarting production. Would Toyota call these employees whistleblowers, or would it view them as responsible self-interested guardians of quality, ensuring its sustainability, aiding its reputation and ultimately building its market value? I know which definition my money is on.



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