Introduction
Effective communication is critical in combating challenges that occur in healthcare. Evidence suggests that upward communication improves healthcare quality and safety (Schein, 2015). Upward communication allows employees to raise concerns and speak out whenever unsafe practices or poor quality care is observed. Despite the relevance of upward communication, patients often suffer, and staff are harmed when serious concerns from frontline staff are not adequately addressed (Mannion & Davies, 2015). As such, whistleblowing has become crucial in raising awareness about unethical, illegal, or unsafe healthcare practices. Although whistleblowing is essential, it requires a supportive environment where employees can air their views, divergent opinions are acknowledged, and effective actions are enacted to promote safer care.
Case Analysis
Discussion of the Problem
The problem identified in the case study is the “intrinsic difficulty of upward communication across professional or hierarchic status boundaries” (Schein, 2015, p.265). The challenge arises from power differences arising from the notion that those in higher authority have the license to tell subordinates what to do. In other words, organizational members assume that managers have a divine right to tell instead of asking and listening and view whistle-blowers as trouble-makers and malcontents who see bad things or safety hazards in organizations.
Consequently, managers only listen when a problem blows up. When this happens, they see the issue as “an exception” and try to eliminate a few bad apples while reminding others of good things happening in the organization. The leaders lack the drive to question their position and fail to acknowledge that subordinates may know things or recommend systematic changes that can improve an organization’s overall functioning (Schein, 2015). Therefore, leaders opt to undertake root-cause analysis and identify individuals to blame instead of evaluating the systemic factors that cause undesirable events.
This problem can be traced to the cultures of voice and silence in healthcare organizations. When healthcare organizations fail to value upward communication, subordinates resort to whistleblowing to disclose information about inappropriate practices to the public or person, outside management structures, and normal channels (Mannion & Davies, 2015). The cultures of silence and voice share several similarities. Whether healthcare organizations have a culture of voice or silence depends on the environment and underlying policies. A culture of voice blossoms where whistleblowers are seen as heroes who champion patient interests and promote better care (Mannion & Davies, 2015). At the same time, healthcare environments that portray whistle-blowers as villains and disloyal malcontents who damage organizational and professional reputations encourage a culture of silence.
However, cultures of silence and voice have critical differences. First, they are caused by different spectrums of informal and formal behaviors embedded in local organizational cultures and contexts (Mannion & Davies, 2015). Although voicing concerns is vital in reshaping healthcare safety, it depends on a spectrum that allows dialogue among colleagues, giving room for second opinions. Informal strategies like sarcasm or humor are valuable mechanisms for cultivating a culture of voice. On the contrary, cultures of silence are caused by organizational, personal, and social factors entrenched in power differences and hierarchical statutes limiting open reporting.
Lastly, the cultures of voice and silence differ in the consequences they produce. Studies have shown that cultures of voice secure effective and safe services. This promotes safe and quality care. On the other hand, cultures of silence produce undesirable outcomes through unsafe care. This harms patients and healthcare providers.
How was the Problem Handled?
The problem was handled using adaptive moves. The first adaptive approach discussed in the case is employing a different method to analyze healthcare problems. For instance, instead of root-cause analysis and blaming people, leaders can assume that subordinates did not intend to cause harm and use a collaborative approach to solve the problem (Schein, 2015). In one of the cases, when electrical workers failed to wear sunglasses because they steamed up during hot days, the employer redesigned the glasses rather than punishing the workers. These adaptive strategies mitigate practical drifts in healthcare settings.
Opinion on How the Problem Was Handled
I agree with the way the problem was handled. According to Schein (2015), addressing practical drifts requires upward communication to understand the system better and design appropriate adaptive moves. Curcuruto and Griffin (2023) affirm that inspiring subordinates to demonstrate active initiative promotes the culture of promotive safety voice. This constructive safety voice offers original problem-solving alternatives or ideas about improving work procedures for the safety of operations. As such, using adaptive strategies to solve the problem in the given case is instrumental in enhancing incremental improvements in safety systems in healthcare.
Additionally, an adaptive move allows senior management to re-evaluate their reactions to views shared by subordinates about quality or safety. They reflect and self-evaluate whether they welcome subordinate inputs, encourage their feedback, acknowledge their relevance, and reward them. This challenges leaders to create a safe environment where subordinates can air their concerns and views.
Moreover, using adaptive responses makes it easy for healthcare organizations to pay attention to “weak signals.” Problems that fatal accidents or trigger whistleblowing start as minor concerns that are identified but not taken seriously or reported. For instance, tensions between nurses and surgeons are weak signals that are ignored from time to time (Schein, 2015). Adaptive moves help identify these minor deviations, allowing managers to collaborate with subordinates to address quality and safety concerns from such weak signals.
Importantly, adaptive moves allow leaders to personalize their relationships with subordinates. This implies that managers get to know subordinates as people instead of occupants of some professional or technical roles. Unless healthcare leaders personalize relationships in various hierarchical boundaries, subordinates cannot feel safe sharing negative information (Schein, 2015). In this case, adaptive moves facilitate openness and build mutual trust, reducing professional distance and promoting a culture of voice. Notably, a combination of the notion of “the divine right of managers” and “professional distance” creates conditions that encourage whistleblowing (Schein, 2015, p.266). Therefore, fostering personalization, trust, and openness to prevent undesirable behaviors can promote a safer working environment in healthcare organizations. This explains why using an adaptive move was the right thing to do.
Relevant Legal, Ethical, and Regulatory Statutes and Standards
Healthcare standards and statutes are critical in supervising and standardizing healthcare and ensuring healthcare providers comply with safety and quality policies. As a result, legal, regulatory, and ethical guidelines are fundamental in formalizing commitment to care quality and safety goals in all countries. From a legal perspective, the US has numerous regulatory frameworks governing whistleblowing in healthcare (National Nurses United, n.d.). For example, the Whistleblower Protection Act provides the best practice standards that explicitly permit whistleblowers to make anonymous or confidential disclosures concerning alleged misconduct. The law also protects former and current HHS employees from retaliation. Also, the Occupational Safety & Health Act (OSHA) protects whistle-blowers from retaliation after disclosing information about unsafe working conditions (National Nurses United, n.d.). Although the regulations vary from one state to another, anti-retaliation laws discourage adverse actions like demotion, termination, pay reduction, layoff, and discipline.
Whistleblowing is a personal reaction to wrongdoing like unsafe care, illegal activity, or unethical behavior. Healthcare professionals who act as whistleblowers are driven by personal integrity, moral values, and professional conscience that apply to healthcare law, human rights, and medical ethics. Wiisak et al. (2022) contend that virtue ethics is the basis for whistleblowing, with courage being a vital human virtue acknowledged in nursing and healthcare. To this end, moral courage empowers people to overcome fears and possible negative consequences to defend personal and professional ethical values and principles (Wiisak et al., 2022). Morally courageous healthcare professionals are ethically sensitive and risk themselves to save others.
Conclusion
Whistleblowing has emerged as a prominent way to identify and address safety and quality issues in healthcare. Evidence from the case study shows that limited utilization of upward communication is the major problem that creates conditions that trigger whistleblowing. However, an interplay of organizational, personal, and social factors influences whether organizations develop a culture of voice or silence. Healthcare leaders can address this challenge through adaptive strategies that foster openness, personalization, and trust. The takeaway from the case analysis is that organizations should create environments that appreciate divergent narratives, allow employees to air their voices, and implement practical measures to improve safety.
References
Curcuruto, M., & Griffin, M. A. (2023). Upward safety communication in the workplace: How team leaders stimulate employees’ voice through empowering and monitoring supervision. Safety Science, 157, 105947. https://doi.org/10.1016/j.ssci.2022.105947
Mannion, R., & Davies, H. T. (2015). Cultures of silence and cultures of voice: The role of whistleblowing in healthcare organizations. International Journal of Health Policy and Management, 4(8), 503–505. https://doi.org/10.15171/ijhpm.2015.120
National Nurses United. (n.d.). Whistleblower protection laws for healthcare workers. National Nurses United. https://www.nationalnursesunited.org/whistleblower-protection-laws-for-healthcare-workers
Schein, E.H. (2015). Whistleblowing: A message to leaders and managers comment on “Cultures of silence and cultures of voice: The role of whistleblowing in healthcare organizations”. International Journal of Health Policy and Management, 5(4), 265–266. https://doi.org/10.15171/ijhpm.2015.207
Wiisak, J., Suhonen, R., & Leino-Kilpi, H. (2022). Whistle-blowers–morally courageous actors in health care? Nursing Ethics, 29(6), 1415-1429. https://doi.org/10.1177/09697330221092341
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