Whistleblowing in Healthcare
WHISTLEBLOWING IN HEALTHCARE•••
The term whistleblowing is a metaphor, apparently derived from a referee's use of a whistle to call a foul in a sporting event. It refers to a disclosure made by a member or former member of an organization about some practice within the organization. Whistleblowing can be internal (disclosure to someone in higher authority in the organization) or external (disclosure to outside persons or organizations such as government agencies, public-interest groups, or the news media). The term is most commonly used to describe disclosure to persons outside the organization, and it is external whistleblowing that is the focus of discussion here.
The whistleblower is a person, usually willing to be identified publicly, who makes an unauthorized disclosure regarding some action or practice within the organization that the person judges to be ethically wrong or unacceptably dangerous. Whistleblowing takes place in business, in government, and in the professions. In healthcare, the most common example in the ethics literature is whistleblowing by nurses about physician behavior. With increased attention being given to ethical issues throughout the healthcare organization, it can be expected that, in the future, the examples of potentially justified whistleblowing in healthcare will be focused nearly as frequently on the business side of the organization as on the clinical side.
Whistleblowing is unauthorized disclosure. As such, it almost always involves activity that management considers disloyal to the organization. In addition, organizations and individuals can be harmed, perhaps in an irreparable manner, by public accusations. Retractions or corrections of false or unfair allegations seldom receive the same degree of public attention as the initial accusations. These considerations of disloyalty and harm have led many ethicists to stress the conditions that must be met before individuals should feel justified in blowing the whistle. It is also important to recognize, however, that the organization has a responsibility to prevent the need for whistleblowing and to treat the whistleblower fairly.
Even when potential whistleblowers are motivated by a desire to protect other individuals or society in general, they need to be careful lest they do more harm than good. Ethical or responsible whistleblowing is usually understood to mean that all of the following conditions are met:
- The person has clear evidence that the organization or someone in the organization is engaged in activity that is seriously wrong or that has a high potential for doing serious harm.
- The charge to be made by the whistleblower is accurate and accusations against any individuals are able to be substantiated.
- The wrongdoing or the danger to be disclosed must be serious enough to justify risking the harm that will likely result to the organization and to some individuals once the public disclosure is made.
- Reasonable attempts to prevent the wrong through internal consultation and reporting have been made and have failed. Potential whistleblowers should attempt to use methods of reporting within the organization before going outside, in spite of the frustrations and delays internal mechanisms can sometimes cause. (It should be recognized, however, that in some situations internal efforts to prevent the wrong are not feasible or would simply lead to an effective cover-up.)
- There is a reasonable possibility that the disclosure will help prevent or mitigate the harm or wrong or that the disclosure will lesson the likelihood that similar actions will occur in the future. (This condition should not be interpreted too rigidly. In many cases, it is exceedingly difficult to calculate the potential consequences that may result from acting. Furthermore, it may sometimes be legitimate just to call attention to the reality in order to have a betterinformed public.)
When these conditions are all met, blowing the whistle might best be considered an ethical responsibility, not just an ethically permissible act; all employees have some responsibility to protect the public from serious harm when possible.
The Organization: Prevention and Protection
While much of the discussion of whistleblowing in the ethics literature has focused on the responsibility of the potential whistleblower, there is also a need to recognize the responsibilities of management. Many healthcare organizations now have corporate compliance programs that have mechanisms for internal reporting of suspected wrongdoing (including anonymous reporting to the compliance officer). However, unless and until employees and medical staff see that changes are made when concerns are raised internally, they will still be faced with the question of whether to go public. Management is in a weak position to claim that an employee should not blow the whistle out of loyalty to the organization if management does not adequately attend to reported problems. One of the key reasons why some nurses believe they have a responsibility to blow the whistle publicly on physician behavior is that their experience is that internal complaints have led to no changes at all.
In addition to following up quickly and with thorough investigations when staff report what they perceive to be serious wrongdoing, management can take other steps to prevent staff from concluding that they have no alternative but to blow the whistle. Those who make internal reports or complaints should be protected from any recrimination or discipline, as long as they make the report in good faith (which should be assumed until proven otherwise). Trying to protect the organization from doing harm should be rewarded, not penalized.
Organizations also have a responsibility to deal fairly with employees who do blow the whistle. In the history of whistleblowing in business, a common outcome has been the firing of whistleblowers. This has been the case, even when there was evidence that the whistleblower did, in fact, expose a serious wrongdoing that was not being addressed internally. It is difficult, if not impossible, to justify ethically the firing of an employee because the person blew the whistle on actions that seriously threaten the public good after making reasonable internal attempts to achieve a change. The ethical healthcare organization recognizes that loyalty to the public good takes priority over loyalty to the employer.
charles j. dougherty (1995)
revised by leonard j. weber
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