Whistleblowing & Psychological safety by Gill Stanyard

Three years ago, just before, I was appointed by the Cabinet Secretary to be a Non-Executive Director  , I became a whistleblower. I blew the whistle on an organisation I had previously worked at. The whole process felt like a mini earthquake happened inside of me – I felt physically shattered, on edge and at times, paranoid due to the fear of not knowing what was going to happen next. I was not kept informed and this was the most difficult thing to endure -I did not feel psychologically safe. However, this was bearable compared to the distress of keeping everything in, all the wrong doing I had witnessed and not knowing what to do or where to take it -this ate away at me until I took action to an external source. Despite the high reading on my internal Richter scale, I felt I had done the right thing.  Looking back, I know I did the right thing.

We have heard a lot lately about Whistleblowing in the press, from Julian Assange to the more recent Dr Jane Hamilton, who met with NHS Scotland Chief Executive and last week’s author of this D & G blog,  Paul Gray,  this month, about her concerns as a Psychiatrist working at NHS Lothian.

So, what does it mean when we talk about Whistleblowing? Public Concern at Work define Whistleblowing as:

A worker raising a concern about wrongdoing, risk or malpractice with someone in authority either internally and/or externally (i.e. regulators, media, MSPs/MPs)

In his Report on the Freedom to Speak Up review (“the Report”) published on 11 February 2015, Sir Robert Francis QC defines a whistleblower, in the context of the NHS, as: “a person who raises concerns in the public interest. An important distinction is to highlight the difference between grievances and concerns -the law around whistleblowing (Public Interest Disclosure Act)  responds to ‘concerns’.

 

Grievances                                Concerns

risk is to self                                  risk is to others

need to prove case                   tip off or witness

   rigid process                               pragmatic approach

legal determination                    accountability

private redress                           public interest

 

Fast forward to this present day, as Chair of Staff Governance, I was nominated last year to take on the role of Whistleblowing Champion for the Board -an assurance role created by Scottish Government for Non-Executive Members in November 2015. This was part of an on-going intention to raise the profile of Whistleblowing being safe to do and as part of a response to one of the recommendations from the Francis Report ‘Freedom to Speak Out’.

As Whistleblowing Champion I will look for assurance that investigations are being handled fairly and effectively including:

• that reported cases are being investigated
• that regular updates are provided on the progress of the investigations of reported cases
• Ensure that staff members who report concerns are being treated and supported appropriately and not victimised
• members of staff are regularly updated on the progress of the concern they reported and advised of investigation outcomes;
• ensure that any resultant actions are progressed.
• Ensure that relevant Governance Committees; HR; staff representatives and Whistleblowing policy contacts are being updated on the progress and outcomes of cases; and, recommended actions resulting from an investigation.
• Publicise and champion positive outcomes and experiences.

 

Around the same time as this role was developed, also in response to the Freedom to Speak Up Review recommendations, the Cabinet Secretary for Health, Wellbeing and Sport announced the development and establishment of the role of an Independent National Officer. This is to provide an independent and external level of review on the handling of whistleblowing cases. This role is still being implemented and recent word from Scottish Government representatives last week, is that focus is on investigating the statutory powers that would need to sit alongside this role, so, it is hoped that the post will be live by 2018. A lot of learning has taken place from the established Guardian scheme in England.

Shona Robison has talked very recently about her desire for all NHS Staff to ‘have the confidence to speak up without fear about patient safety.’ Dame Janet Smith, back in 2004,  when she helped to develop proposals following the Shipman Enquiry wrote “I believe that the willingness of one healthcare professional to take responsibility for raising concerns about the conduct, performance or health of another could make a greater potential contribution to patient safety than any other single factor.”

The Right Honourable  Sir Anthony Hooper, in his report on the handling by the GMC to cases involving whistleblowing (2015) revealed an issue around bullying.  The GMC has recognised that the bullying of those who raise concerns may make persons reluctant to do so. A GMC survey (published in November 2014) of the 50,000 doctors in training found nearly one in ten reporting that they had been bullied, while nearly one in seven said they had witnessed it in the workplace. At the time of the publication Mr Niall Dickson said: “There is a need to create a culture where bullying of any kind is simply not tolerated. Apart from the damage it can do to individual self-confidence, it is likely to make these doctors much more reluctant to raise concerns. They need to feel able to raise the alarm and know that they will be listened to and action taken.’ What I see Dickson referring to is the creation of psychological safety,  defined as ‘…a belief that it is absolutely ok, expected even, that people will speak up with concerns, with questions, with ideas and mistakes…’  Amy Edmondson, Professor in Leadership , Harvard University

Recently I came across this painting by Gozzolli depicting the story of St Jerome and the Lion.  I had vague recollections of this story from one dusty morning spent at Sunday School, where I thought the golden motes falling in front of the window were a sign from God that it was ok to eat the mini eggs next to the toy donkey on the Easter shrine. Turns out it was just dusty sunshine and the ‘eggs’ were mint imperials in disguise. .   In the story, a lion approaches St Jerome and other monks whilst they were saying prayers in the monastery -whilst the other monks fled with fear out of the window, running for weapons and other ways to attack and scare the lion away, St Jerome sat quietly and looked into the lion’s eyes. He saw pain reflected back at him, and with pricked curiosity, he watched the lion limp up to him and hold out its heavy front paw.  Jerome took the paw and examined it.. He saw the limb was swollen, and with closer inspection saw there was a thorn embedded in the pad. He removed the thorn and bathed the area with healing herbs and water and placed a bandage of linen cloth around the paw.. Expecting the lion to leave, he sat back and waited. The lion looked at him, now with all  trace of pain gone and lay down on the floor and went to sleep. The lion was said to have never left Jerome’s side.

What strikes me about the lion is his courage and self-compassion to remove the source of his own pain and to take action to do so, despite the risks of being attacked by the monks. Whilst of course it was not in the public interest whether the thorn was removed or not from the lion’s paw in whistleblowing cases it is widely recognised that the whistleblower does suffer before, with the burden of needing to speak out and after, with the worry of the consequences of what may happen next. Robert Francis  acknowledged this in his report ‘Freedom to Speak Out’  ‘… that the stresses and strains of wanting to do the right thing can be immense’  Last September I attended a Whistleblowing event at the Royal College of Surgeons in Edinburgh. One of the speakers was  Dr Kim Holt, Consultant Paeditrician and founder of Patients First. She flagged up concerns to senior management in 2006 about understaffing and poor record keeping at St Ann’s clinic, part of Great Ormond Street Hospital. Sadly, her concerns were not acted upon and in 2007, Baby P died just three days after being seen by a locum doctor at the same clinic, who failed to spot that the toddler was the victim of serious physical abuse. Dr Holt, now recognised by the Health Service Journal as one of the most inspirational women in healthcare, spoke with calmness about the impact her experiences had on her well-being, including becoming severely depressed and unable to eat or sleep. She became a whistleblower, she says, because she feared something terrible would happen to a child and was devastated when her warnings were ignored.

I know it takes courage to speak up and share your concerns. I also know for a fact that we have quite a few St Jerome types here in NHS Dumfries and Galloway.

Our Whistleblowing Policy here at NHS D&G -take a look if you are not familiar :

Click to access Whistleblowing_Policy.pdf

The two people named in the policy are Deputy Nurse Director Alice Wilson – Tel. 01387 272789   and Deputy Finance Director Graham Stewart – Tel 01387 244033

These people have been given special responsibility and training in dealing with whistleblowing concerns. If the matter is to be raised in confidence, then the staff member should advise one of the designated officers at the outset so that appropriate arrangements can be made.

If these channels have been followed and the member of staff still has concerns, or if they feel that the matter is so serious that they cannot discuss it with any of the above, they should contact: Caroline Sharp, Workforce Director NHS Dumfries and Galloway (Tel : 01387 246246)

Also, the national helpline run by Public Concern at Work is called the National Confidential National Confidential Alert Line – 0800 008 6112

Gill Stanyard is a Non-executive member of NHS Dumfries and Galloway Health Board

 

 

Speaking out: A Student’s Perspective by Ren Forteath

I was recently asked to speak at a conference organised by our consultant midwife on the topic of Person Centred Care. She wanted to hear thoughts on the topic of ‘Speaking Out’ from a variety of perspectives and asked me as a midwifery student on placement. I was delighted to be asked to present, perhaps the first indication that speaking out may not be something I find overly daunting! Having a background in amateur dramatics gives me an advantage when it comes to assessed presentations or even leading parentcraft classes when on community placement. The same could not be said of everyone in my class. Even approaching the end of our final year, many of my peers quake with nerves when asked to give a presentation. This fact caused me to consider ‘speaking out’ not only from my point of view, but from that of other students who might be younger and less outgoing than myself. (As a mature student I have quite a few years on some of my class!) The topic encompasses a variety of scenarios, and I tried to think of personal experiences that illustrated my feelings.

On a shift to shift basis we speak to women we care for, other students, midwives and doctors – and sometimes that is no less nerve racking than giving a presentation! Naturally as we progress through our course we become more confident, we gain more knowledge and our comfort zone broadens. But inside there is always a kernel of fear that we’ll say the wrong thing – or not say the right thing. Personally, I’ve had a couple of experiences that spring to mind.

In first year I was with a woman who had written in her birth plan that if things didn’t go as expected and she needed help, she would rather have a kiwi delivery than forceps. I thought no more about it until we reached that point. The reg was called in to do an assisted delivery – and he immediately went for forceps. The woman was fairly out of it on diamorphine and becoming distressed. She couldn’t speak up for herself.  So, I swallowed my fear, took a deep breath and said…’eep’. Then I took another deep breath and said “Doctor, um , she’d really prefer the kiwi, if you don’t mind, please, thank you very much”.  And he did it! She got her kiwi delivery and she was so happy. And I was absolutely on top of this world! It was so exhilarating. I had been an advocate for my woman. I had spoken up to a doctor – and he hadn’t bitten my head off! And then second year happened.

I was on shift and we heard an emergency buzzer, so we all ran to room 7: and it was a shoulder dystocia skills drill. Well, really, what were we expecting? There was only one woman in labour that day and she was in room 3! So one person took charge and started working through the HELPERR mnemonic and I thought “hey, I remember this, I know this stuff”. Then the consultant walked in, made a quick assessment of the situation and said “O.K. with a little fundal pressure, I think we can get this baby delivered.” Everyone else just looked at each other and I was thinking “that’s not right  – I know that’s not right – it’s suprapubic pressure.” And then someone suggested doing exactly that but the consultant said again “Come on now,  a bit of fundal pressure! Please, will someone put their hand on the fundus?” And I thought “it’s not right, is it?” And as if of its own accord, my hand started to move. Well, his voice was just so hypnotically consultanty. Then my mentor shot me such a daggers glance that, seriously, if looks could kill, that midwife would be in prison today! My hand shot back down, but not before at least two other people had seen it. So that sparked a useful discussion on listening to your inner voice and always speaking up, diplomatically, if your knowledge of evidence based practice tells you something is wrong. It also sparked a debate on whether it’s appropriate to use ‘making the student feel like a prize turnip’ as a teaching technique. And I wished the floor would open up and swallow me whole.

And now I’m in third year. There is light at the end of the tunnel and I’m beginning to believe it is not an oncoming train. I still have a lot to learn but I’m really starting to feel like part of the team. I suggest things and people listen. I coach women through fear and panic to relief and joy. I hold my own.

A large part of how easy or difficult it is to speak out is the people you are surrounded by. In my clinical area we have great teams, both in hospital and on the community. My classmates who have been here on rural placement always say how much they enjoy it; the working environment, the attitude, the team. People are encouraging, patient, willing to listen and keen to teach. They are inclusive and welcoming. I have rarely been berated for starting to do something the way I was shown at Uni rather than the way the midwife I was working with that day would normally do it. Not never, unfortunately, but rarely and never by a mentor.

Having my student placements there has made my own experience a hugely positive one and has equipped me to find my voice and to know how and when to use it. I know that many in my class feel the same way about their mentors in their own areas. Speaking up and speaking out are still not always easy…. but we’re learning, and as we complete our degree programmes and step out into the wards as shiny new midwives, we will find the strength to speak for our women, and for ourselves.

• Trust your learning – if your evidence base tells you it isn’t right, say something (even to a consultant)
• You are her advocate – if she can’t speak for herself, it’s your job to speak for her
• Be diplomatic – just because you need to say it, that doesn’t mean you have to upset anyone
• Find your voice – you can have a positive impact by saying the right thing at the right time

Ren Forteath is a Student Midwife