This is a ‘hot topic’ currently and there have been a number of high profile cases in recent times. It is very actively discussed on social media, and I recently attended the first conference of Patients First that was jointly hosted with the BMA.
Much of the anxiety, with good reason, is centred on why senior managers like myself seem all too often to suppress concerns that are raised, and seek to silence or even punish those who raise them. No right-thinking person would support such actions, and it is to be condemned when it is found to occur.
But, in my own experience, there are other facets to this complex topic that are much less often discussed, particularly when a doctor is either the whistleblower, or the target of a whistleblower.
Firstly, any concern raised about a colleague is very often followed by a counter claim of either poor performance or poor behaviour. This means there are very quickly two ‘whistleblowers’, with opposing concerns, raising the possibility that one is dealing with a relationship difficulty rather than a genuine concern about clinical standards.
This is compounded by the high frequency of antecedent relationship difficulties involving either the two individuals, or their clinical grouping. This does muddy the waters because there may be a motive that is not patient safety or well being. Should this be treated as whistleblowing, or as a behavioural/team working issue? It depends on the circumstances of course, but it is one reason why a ‘whistleblower’ may feel appropriate action is not being taken.
The second difficulty that we face is the sheer difficulty of following up concerns that are raised about the performance of a doctor. How does one determine whether an individual doctor is performing well, or poorly? What measures should we use?
Over ten years after Bristol and the Kennedy report, it is still only the cardiothoracic surgeons who are measuring and publishing outcomes (and I gather they stopped for a while and only recently re-started). So pity the poor CEO or Medical Director who has the job of investigating the concerns that have been (usually legitimately) raised.
I realise I am in contentious territory here, and I have not mentioned the other aspect of whistleblowing that might be further explored, at another time, which is that it is frequently used as a defence against accusations of poor performance by management.
The common denominator here is the measurement of an individual doctor’s performance. Until we work out how to do this – fairly, appropriately, and in a meaningful way, then we will continue to struggle when concerns are raised.
We can of course continue to berate managers for failing to listen or, worse, for suppressing individuals who raise concerns. And we should. But we should also acknowledge that it is very difficult for them to act, because the profession is still resistant to addressing the challenge of measuring and monitoring the effectiveness of doctors.
It is a gap that will be filled, I’m sure. If the profession do not do it, then others will. And they will be less likely to successfully address the huge complexities involved.
This blog was originally posted on the HospitalDr website here on 10 December 2012