Clinical governance breakdown: Australian cases of wilful blindness and whistleblowing

Abstract

Background: After their attempts to have patient safety concerns addressed internally were ignored by wilfully blind managers, nurses from Bundaberg Base Hospital and Macarthur Health Service felt compelled to 'blow the whistle'. Wilful blindness is the human desire to prefer ignorance to knowledge; the responsibility to be informed is shirked. Objective: To provide an account of instances of wilful blindness identified in two high-profile cases of nurse whistleblowing in Australia.Research design: Critical case study methodology using Fay's Critical Social Theory to examine, analyse and interpret existing data generated by the Commissions of Inquiry held into Bundaberg Base Hospital and Macarthur Health Service patient safety breaches. All data was publicly available and assessed according to the requirements of unobtrusive research methods and secondary data analysis. Ethical considerations: Data collection for the case studies relied entirely on publicly available documentary sources recounting and detailing past events. Findings: Data from both cases reveal managers demonstrating wilful blindness towards patient safety concerns. Concerns were unaddressed; nurses, instead, experienced retaliatory responses leading to a 'social crisis' in the organisation and to whistleblowing. Conclusion: Managers tasked with clinical governance must be aware of mechanisms with the potential to blind them. The human tendency to favour positive news and avoid conflict is powerful. Understanding wilful blindness can assist managers' awareness of the competing emotions occurring in response to ethical challenges, such as whistleblowing.

Unprofessional conduct by nurses: A document analysis of disciplinary decisions

“…Other issues included lack of managerial abilities, high workload, lack of resources and working in haste or distractions during nursing tasks. 2,8,53,54 A nurse's unprofessional conduct does not just affect them; it also affects patient safety. In addition, nursing colleagues may be placed in a difficult situation if they are not sure whether to report suspicious incidents relating to a nurse.…”

Uncovering, creating or constructing problems? Enacting a new role to support staff who raise concerns about quality and safety in the English National Health Service

“…In such situations, as the Guardians and some others we interviewed reported, independence or formal accountabilities may seem less important to potential speakers than the ability to understand and help make sense of the complex situations they faced. This is not to suggest that acts of whistleblowing in the narrower sense of the term should be disregarded: on the contrary, whistleblowers' actions have been crucial in exposing persistent problems of omission or commission in several systems (Bristol Royal Infirmary Inquiry, 2001;Cleary and Duke, 2019;Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013). It is, however, to note that Guardians' contribution in supporting whistleblowers (a key part of the role as intended in policy: see Department of Health, 2015;Francis, 2015) remains as yet unproven -and indeed appears from our study and from other evidence (cf.…”

“…There is some consensus that voice may offer especially valuable insights about problems that are not readily detected through formal, measurable indicators (Martin et al, 2015), and that it may be especially useful in highrisk settings in identifying risks to safety (Macrae, 2014). But, despite evidence that failures of voice have been implicated in crises in healthcare worldwide (Cleary and Duke, 2019;Newdick and Danbury, 2015;Weick and Sutcliffe, 2003), challenges in encouraging and responding to voice are widely reported within healthcare (e.g. Jones and Kelly, 2014a) and beyond (e.g.…”

La dénonciation infirmière en contexte de pandémie de COVID-19: une analyse de contenu de la plate-forme « Je dénonce »

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