Professor Amélie Perron of the School of Nursing at uOttawa’s Faculty of Health Sciences, has been interested in this question for a decade. Her most recent study looks at the aftermath of whistleblowing: how do managers react to these sensitive situations? And what’s at stake for everyone involved?
Protecting the quality of care
In 2017, Perron, a psychiatric nurse, co-founded the Nursing Observatory, a research team whose work focuses on whistleblowing in health care. At the time, Quebec nurses were making headlines for speaking out about their working conditions, including mandatory overtime, and the risks to quality of care and patient safety. These events encouraged Perron to undertake an initial study, funded by the Social Sciences and Humanities Research Council of Canada (SSHRC) and launched a few weeks before the start of the COVID-19 pandemic, to record the experiences of 40 nurse whistleblowers in Quebec.
“The stories dealt with situations that occurred before or during the pandemic, regarding patient care, rights and safety. That was the prime motivation of our participants, the reason they blew the whistle,” says Perron.
Whistleblowers disclosed, for example, practices that violated patients’ rights, such as abusive use of patient restraints, poor medication management and violations of the dignity of long-term care patients. Certain accounts highlighted toxic management practices in nurses’ workplaces. Others criticized situations that resulted in avoidable deaths.
While some whistleblowing led to the implementation of corrective measures, Perron says, in other cases, it led to troubling outcomes: well-documented issues were ignored by management and nurses were accused of insubordination and suffered retaliation.
Management behind the scenes
These accounts led to a cross-Canada study, also funded by SSHRC, looking at how health-care managers and senior administrators handle information disclosed by whistleblowers. Is the concern investigated or is a culture of silence encouraged?
For Perron, the issues are more complex than a simple employer-staff conflict. Beyond individual or interpersonal dynamics, we must look at organizational and systemic factors influencing the perception and management of disclosures. Managers must sometimes deal with structural constraints that limit their ability to intervene. In some cases, those who try to address concerns experience retaliation themselves. Despite the power their positions give them, managers can be vulnerable within their organizations. This reality explains in part the difficulty in recruiting mid- or senior-level executives to take part in the study, Perron adds. Some participants who wish to share their perspectives back out at the last minute.
“Whistleblowing shouldn’t cause this much discomfort,” Perron says. “It’s part of the quality assurance mechanisms in health care and helps ensure patient safety, workplace integrity and respect for the law and for patients’ and families’ rights. In theory, everyone should view it favourably.”
Unfortunately, whistleblowers who report wrongdoing in their workplace, and managers who try to address it, take considerable risks, says Perron. She stresses the importance of improving institutional and legal protections for those who dare to speak out, to counter the culture of silence.