How do we know about traumas inflicted by harmful cultures in healthcare institutions? Well, somebody has to tell us. More often than not, healthcare institutions are hermetically closed to outsiders and any wrongdoing is kept within the walls.
That is unless someone on the inside decides to blow the whistle and lay bare the practices of the institution to public scrutiny. I have looked at the role of whistle-blowers in the Mid Staffordshire Hospital scandal, and there is a general pattern emerging from this. A pattern where whistle-blowers and transparency substitute authorities and secrecy in terms of defining institutional cultures.
A short history of blowing whistles
The term ‘whistle-blower’ is relatively new. Coined by the American political activist Ralph Nader during the Pentagon Papers scandal in the early 1970s, it was meant to replace negative labels such as ‘informer’, ‘traitor’ or ‘snitch’. The term caught on, and since then it has become widely used to describe people who go public with their concerns over practices at their workplace. Some of the most prominent examples outside healthcare include Edward Snowden and Chelsea Manning, both of whom have suffered severe consequences of their whistleblowing.
Whistle-blowing is basically divided into two categories: internal and external. In internal whistle-blowing, the exposure is kept within the institution, which then takes the measures it finds necessary. These instances rarely become public knowledge. External whistle-blowing, on the other hand, often happen via the media, which ensures a wide dissemination of the allegations.
In the healthcare sector, whistleblowing is only now becoming a point of concern, partly as a result of the Mid Staffordshire hospital scandal. But with the rise of whistle-blowers, more and more examples of wrongdoing in care institutions are coming to the fore.
Lying in soiled bed sheets
In the case of the Mid Staffordshire hospital scandal, which happens to be my area of expertise, whistle-blowers played a key part. The hospital’s known failures can be dated back to at least the early 2000s when patients died and suffered in the hands of a system that was supposed to care for them. These failings came to the attention of the media and the wider public with the publication of a series of inquiries and reports.
From the beginning of the scandal, the accounts of whistle-blowers were central to the narrative. They told harrowing stories of patients lying in soiled bed sheets, no food or water, and the staff’s fear of speaking out. Furthermore, the use of confidentiality agreements in the NHS, or ‘gagging clauses’ as the media dubbed them, came under scrutiny. The closed nature of healthcare institutions was questioned and the whistle-blowers became celebrated as heroes.
However, as the dust of scandals settles, whistle-blowers are often forgotten about. By blowing the whistle, they have alienated themselves from their former employers, and when the public attention fades few people care about their fate. As a result of the Mid Staffordshire hospital scandal there have been initiatives to protect whistle-blowers from repercussions, but the issue of whistleblowing in the healthcare sector is still a point of discussion.
A transparent society
The rise of the whistle-blower is a part of a new visibility in society. We are less likely to tolerate the secrecy of institutions and demand to have insight into how they work. The whistle-blowers help us achieve this. By telling us whenever something is wrong in the institutions they work for, they expose wrong and harmful practices. Usually, this is followed by placing accountability and institutional reform.
This development is a part of a general tendency of distrust in authorities and institutions. When harmful practices are exposed, they are often linked to other failings, thereby creating the impression that the entire healthcare system is failing. Whistle-blowers help reveal harmful practices, but the price for this transparency can be high, both for them personally and for healthcare institutions in general.
Suggested video for blog post: http://www.bbc.co.uk/news/health-21462085
Jon Eilenberg is a PhD researcher at the Centre for Law Justice and Journalism based at City University London, where he looks at institutional failings and mediatised scandal using the Mid Staffordshire hospital scandal as case study.