Senior stakeholder views on policies to foster a culture of openness in the English National Health Service: a qualitative interview study.
Martin, Graham Paul
J R Soc Med
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Martin, G. P., Chew, S., & Dixon-Woods, M. (2019). Senior stakeholder views on policies to foster a culture of openness in the English National Health Service: a qualitative interview study.. J R Soc Med, 112 (4), 153-159. https://doi.org/10.1177/0141076818815509
OBJECTIVES: To examine the experiences of clinical and managerial leaders in the English healthcare system charged with implementing policy goals of openness, particularly in relation to improving employee voice. DESIGN: Semi-structured qualitative interviews. SETTING: National Health Service, regulatory and third-sector organisations in England. PARTICIPANTS: Fifty-one interviewees, including senior leaders in healthcare organisations (38) and policymakers and representatives of other relevant regulatory, legal and third-sector organisations (13). MAIN OUTCOME MEASURES: Not applicable. RESULTS: Participants recognised the limitations of treating the new policies as an exercise in procedural implementation alone and highlighted the need for additional 'cultural engineering' to engender change. However, formidable impediments included legacies of historical examples of detriment arising from speaking up, the anxiety arising from increased monitoring and the introduction of a legislative imperative and challenges in identifying areas characterised by a lack of openness and engaging with them to improve employee voice. Beyond healthcare organisations themselves, recent legal cases and examples of 'blacklisting' of whistle-blowers served to reinforce the view that giving voice to concerns was a risky endeavour. CONCLUSIONS: Implementation of procedural interventions to support openness is challenging but feasible; engineering cultural change is much more daunting, given deep-rooted and pervasive assumptions about what should be said and the consequences of mis-speaking, together with ongoing ambivalences in the organisational environment about the propriety of giving voice to concerns.
Humans, Whistleblowing, Social Perception, Qualitative Research, Civil Rights, Freedom, Administrative Personnel, Policy Making, State Medicine, Organizational Culture, Organizational Objectives, England, Stakeholder Participation, Work Engagement
GPM acknowledges the support of the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM). MDW and GPM are supported by the Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies (THIS) Institute. THIS Institute is supported by the Health Foundation—an independent charity committed to bringing about better health and health care for people in the UK. MDW is a Wellcome Trust Investigator (award WT09789) and a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Wellcome Trust (097899/Z/11/Z)
National Institute for Health Research (NIHR) (via University of Leicester) (RM62G0760)
Health Foundation (unknown)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10026)
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External DOI: https://doi.org/10.1177/0141076818815509
This record's URL: https://www.repository.cam.ac.uk/handle/1810/287208
Attribution 4.0 International
Licence URL: https://creativecommons.org/licenses/by/4.0/