I have wanted to get back to research and write about whistle blowing in health care but have not yet done so .This page only touches briefly on whistleblowing and dissent in health care. It examines the context of whistle blowing. When do people speak out and when do they remain silent?
The status which an individual or a group enjoy in a particular situation is a good predictor of the likelihood that they will blow the whistle. Nurses and doctors are good examples.
Nurses and Whistleblowing: - It is interesting that nurses have at times been part of the corporate process and at other times have blown the whistle. In Tenet/NME and other psychiatric hospitals nurses were promoted as nurse managers and given large powers. They became part of Tenet/NME's "intake culture". They were encouraged to overrule decisions made by doctors. They were very much part of the system enjoying stature and rewards. They acted out their lives and acquired a positive sense of who they were. "I am the supervisor". They did not blow the whistle.
In aged care nurses were underpaid and overworked. Skilled staff were replaced with nurse aids. Their experiences and their sense of who they were was negative. Nurses have been at the forefront in exposing what was happening in aged care but were ignored because they were considered to be self interested.
In a distrustful market society anyone with any sort of personal interest in changing the system is immediately discredited and attacked. It was only when ordinary citizens outside the nursing home service acted that anything happened.
Doctors and whistle blowing: - Doctors have not performed as well in speaking out about failures in the system although there were a number of individual medical whistleblowers in the psychiatric scandal. These were the people who were marginalised and suffered because they were not "team players". As a group doctors benefited from the system and did not speak out. They cooperated in labeling and discrediting medical whistle blowers. Medical Associations were silent.
Under managed care medical team players have been well rewarded and those who speak out have been penalised. Overall however many doctors have had their authority challenged and their financial status threatened. Medical groups have consequently been motivated to expose the deficiencies of managed care. They have been much more vocal in their criticisms. In Australia they have rejected it outright. Predictably they have been accused of self interest. The Australian Consumer Association labeled this "managed scare". Unfolding events in the USA have proved the doctors to be right.
Patients and patients relatives:- These are the people at the receiving end of the health and aged care service. They have no investment in it and suffer most when it fails. They are relatively powerless and lack credibility and status. They are not part of the formal structure of health care and have no loyalty to it. They carry the values of the community and assume that the health and aged care system represents the expression of those values. They are affronted by breeches in care when these reflect a failure to serve the community's values. They are often highly motivated and very determined. It is not surprising then that they have been the most effective in exposing deficiencies in care. An excellent example of the way a personal experience can motivate someone and the enormous difference a determined whistle blower can make is well illustrated by Ila Swan who has been a driving force in exposing the US corporate aged care scandal.
Click Here for more about Ila Swan.
Implications: - The point I am making is that we are all human and profoundly influenced when our personal welfare is at stake. There is a strong tendency for people to adopt theories and explanations which are congruent with their well being. Employees can be subjected to strong positive or negative commercial pressures in the working environment. In a positive context where staff are beneficiaries most will become team players and identify with the dysfunctional system. Whistle blowing is less likely. When there is no personal benefit people will speak out much more readily. When people are adversely affected themselves they will often become highly motivated.
I am not being judgmental or blaming fat cats for abandoning their principles. I am trying to show that we are human and that this is how most humans behave. It has predictive value.
I have written about paradigm conflicts and the importance of identity in other pages. The ability to realise a positive identity is a major factor inducing people to suppress paradigm conflicts and act out discordant paradigms.
Samuel proposes a complex system which depends on multiple opposing financial pressures. It is a recipe for disaster - a US style disaster. It is simply too complex and too difficult to use commercial forces in this way. It creates all sorts of paradigm conflicts which are likely to have unpredictable but largely negative consequences.
Outcomes: - We cannot accept a market system of health care which encourages people to divert as much of the available resources to profit as they can get away with. In a corporate market system financial priorities are a life and death matter for the company and those who perform well financially achieve status and wealth - a large "I am somebody".
The welfare and careers of the employees will be tied to the financial viability of the company and their contribution to this. Experience from the US system tells us that we must expect the majority to identify with dysfunctional corporate practices and also to assist in covering up deficiencies. Whistle blowing will be uncommon.
It would be much more sensible to develop a
system where pressures away from care are eliminated and replaced by
humanitarian motivation - a Samaritan spirit. We need a system which
provides the best context - a system where people are motivated to
stretch limited resources as for as possible - a system which
capitalises on our humanity and addresses the nuances of individual
Probably most of the revelations about corporate misconduct originate with whistle blowers. Many of the stories are interesting and very revealing of corporate thinking and behavior - as well as the sort of people who blow the whistle. There are the stories of James Alderston, an accountant who brought Columbia/HCA crashing down, Dr. Olivieri who stood up for her patients in Canada, and Ila Swan whose persistence in exposing the neglect of the aged in California ignited a flame which spread across the USA. I mention these people in passing on this www site but there are many others.
These people deserve www pages of their own and they are on my futures list.