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Richard Smith recently shared this editorial he wrote more than thirty years ago, on the subject of preventing whistleblowing. It seems entirely relevant to the present day.

I was particularly struck by this passage:

Most organisations eventually have to take tough decisions. Difficult choices, particularly over allocating resources, have long been part of working in the NHS. The choices will become tougher, and there may be more losers than winners. The fear that the losers will tell all to the media is what leads managers to reach for their gags. They make a mistake. Instead, they need to create organisations-be they hospitals or health authorities -where employees feel enough part of the decision making process not to need to blow their whistles.

You begin by letting everybody know what is going on. If the rhetoric is glossy brochures full of the word “quality” and the reality is elderly patients with pressure sores in back wards with peeling paint, then staff will become cynical and demotivated. They need to be convinced that the available resources are used fairly, efficiently, and effectively. The surest way to convince them is to involve them in decision making. The decisions that are made must be clearly and honestly communicated. Staff must have a chance to come back on poor decisions, and managers should not be afraid to reverse decisions that are wrong.

If staff understand the true circumstances of the organisation and feel that their views have been given serious attention then they will accept tough decisions. But if seemingly arbitrary decisions appear from nowhere then staff will be unhappy and one or two will contact the press. Managers who try to create a climate of fear will neither stop whistle blowing nor run an effective health service.

That second paragraph is remarkable: it is common sense, it has been clearly articulated for more than thirty years, yet it is seldom followed.

The difficulty so often seems to come at the point of involving people in decision-making. Frequently, efforts to do this appear as cynical attempts to justify decisions that have already been taken. This isn’t solely a problem in the health service: we can see similar cynicism, for example, towards the ongoing consultation about closing railway ticket offices.

If we choose to be as uncynical as possible, then it strikes me that this often boils down to poor communication. Smith talks about ‘glossy brochures full of the word “quality”’—and I think he’s right. Starting a conversation about funding cuts with rhetoric around ‘quality’ and ‘efficiency’ drives cynicism more than collaborative decision-making. Too frequently, managers fear being honest, and too often, managers choose not to be plain-spoken. You cannot have shared decisions if the people sharing in the decision have no idea what you’re talking about.

This post was filed under: Health, Post-a-day 2023, , .

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