Rights statement: This article has been accepted for publication in Journal of Medical Ethics, 2022 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/ medethics-2022-108328
Accepted author manuscript, 562 KB, PDF document
Available under license: CC BY-NC: Creative Commons Attribution-NonCommercial 4.0 International License
Rights statement: This article has been accepted for publication in Journal of Medical Ethics, 2022 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/jme-2022-108328
Accepted author manuscript, 562 KB, PDF document
Available under license: CC BY-NC: Creative Commons Attribution-NonCommercial 4.0 International License
Final published version
Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
}
TY - JOUR
T1 - Organisational failure
T2 - rethinking whistleblowing for tomorrow’s doctors
AU - Taylor, Daniel James
AU - Goodwin, Dawn
N1 - This article has been accepted for publication in Journal of Medical Ethics, 2022 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/jme-2022-108328
PY - 2022/10/31
Y1 - 2022/10/31
N2 - The duty to protect patient welfare underpins undergraduate medical ethics and patient safety teaching. The current syllabus for patient safety emphasises the significance of organisational contribution to healthcare failures. However, the ongoing over-reliance on whistleblowing disproportionately emphasises individual contributions, alongside promoting a culture of blame and defensiveness among practitioners. Diane Vaughan's 'Normalisation of Deviance' (NoD) provides a counterpoise to such individualism, describing how signals of potential danger are collectively misinterpreted and incorporated into the accepted margins of safe operation. NoD is an insidious process that often goes unnoticed, thus minimising the efficacy of whistleblowing as a defence against inevitable disaster. In this paper, we illustrate what can be learnt by greater attention to the collective, organisational contributions to healthcare failings by applying NoD to The Morecambe Bay Investigation. By focusing on a cluster of five 'serious untoward incidents' occurring in 2008, we describe a cycle of NoD affecting trust handling of events that allowed poor standards of care to persist for several years, before concluding with a poignant example of the limitations of whistleblowing, whereby the raising of concerns by a senior consultant failed to generate a response at trust board level. We suggest that greater space in medical education is needed to develop a thorough understanding of the cultural and organisational processes that underpin healthcare failures, and that medical education would benefit from integrating the teaching of medical ethics and patient safety to resolve the tension between systems approaches to safety and the individualism of whistleblowing.
AB - The duty to protect patient welfare underpins undergraduate medical ethics and patient safety teaching. The current syllabus for patient safety emphasises the significance of organisational contribution to healthcare failures. However, the ongoing over-reliance on whistleblowing disproportionately emphasises individual contributions, alongside promoting a culture of blame and defensiveness among practitioners. Diane Vaughan's 'Normalisation of Deviance' (NoD) provides a counterpoise to such individualism, describing how signals of potential danger are collectively misinterpreted and incorporated into the accepted margins of safe operation. NoD is an insidious process that often goes unnoticed, thus minimising the efficacy of whistleblowing as a defence against inevitable disaster. In this paper, we illustrate what can be learnt by greater attention to the collective, organisational contributions to healthcare failings by applying NoD to The Morecambe Bay Investigation. By focusing on a cluster of five 'serious untoward incidents' occurring in 2008, we describe a cycle of NoD affecting trust handling of events that allowed poor standards of care to persist for several years, before concluding with a poignant example of the limitations of whistleblowing, whereby the raising of concerns by a senior consultant failed to generate a response at trust board level. We suggest that greater space in medical education is needed to develop a thorough understanding of the cultural and organisational processes that underpin healthcare failures, and that medical education would benefit from integrating the teaching of medical ethics and patient safety to resolve the tension between systems approaches to safety and the individualism of whistleblowing.
KW - obstetrics
KW - truth disclosure
KW - education
U2 - 10.1136/jme-2022-108328
DO - 10.1136/jme-2022-108328
M3 - Journal article
C2 - 35803713
VL - 48
SP - 672
EP - 677
JO - Journal of Medical Ethics
JF - Journal of Medical Ethics
SN - 0306-6800
IS - 10
ER -