Mid Staffordshire National Health Service Research Articles

The Lost Good Self: Why the whistleblower is hated and stigmatized

In this paper I develop a new explanation that furthers our understanding of why whistleblowers are frequently hated and stigmatized. I call into question the implicit assumption in the literature that whistleblowers are hated and stigmatized exclusively because they represent the ‘other’. Instead, I take a different view and argue that, especially where staff have a moral commitment to their work, whistleblowers may also be felt to be problematic because they unconsciously represent the lost good ‘self’ of staff members. I draw on Kleinian psychoanalytic ideas in developing theory, and use the crisis at the Mid Staffordshire National Health Service Trust in the UK as a contemporary case illustration. This paper contributes to the whistleblower literature as well as to the literature that applies psychoanalytic ideas to the study of management and organization, and it also identifies areas for future research.

Incident reporting behaviours following the Francis report: A cross-sectional survey.

Previous studies have shown a lack of engagement in the reporting process. There is limited evidence about whether attitudes and behaviours of doctors in the UK towards incident reporting have changed following the events at Mid Staffordshire National Health Service Foundation Trust and the recommendations that followed. We conducted a relatively large survey of doctors, aiming to assess whether doctors recognised incidents and reported them accordingly, along with their behaviours towards reporting and their suggestions of how incident reporting may be improved. A cross-sectional survey of doctors was undertaken in 11 hospitals in the north of England. The participants (n=581) were invited to take part in an electronic questionnaire. Demographics were obtained, and engagement with the incident reporting process was assessed, including an estimate of the number of incidents which were witnessed but not actually reported. Factors which influenced reporting behaviours were recorded. Free-text comments were encouraged. A mixed method analysis of the responses was performed. Doctors do not appear to be engaging with the incident reporting process-in particular, junior doctors. The main reason given for not completing forms was not having enough time (38.2% of respondents), primarily due to the length and complexity of forms. Many doctors, 43.7%, witnessed more than 5 incidents, but only 13.3% of doctors submitted more than 5 reports. Free text comments revealed 4 themes which impact upon reporting behaviours: organisational issues, form structure, a culture of blame, and a lack of feedback. Several suggestions for improvement were made. Little has changed in the attitudes and behaviours of doctors. Improving incident reporting form structure to make it more user-friendly and improving feedback may engage doctors and lead to an improved safety culture. The way the medical profession reports serious and other incidents still needs to be improved.

What causes imbalance in complex service networks? Evidence from a public health service

PurposeService networks are inherently complex as they comprise of many interrelated actors, often driven by divergent interests. This can result in imbalance, which refers to a situation where the interests of at least one actor in a network are not secured. Drawing on the “balanced centricity” perspective, the purpose of this paper is to explore the causes of imbalance in complex service networks.Design/methodology/approachAdopting a qualitative case-based approach, this paper examines a public health service network that experienced imbalance that was detrimental to the lives of its users: the Mid-Staffordshire National Health Service (NHS) Trust, UK. Drawing on service-dominant logic and stakeholder theory, case evidence provides insight into the origin and drivers of imbalance in complex public service networks.FindingsThe origin of imbalance stems from competing institutional logics of various actors (patients/public, employees, managers, regulatory bodies, etc.), but the degree to which these competing institutional logics lead to imbalance is moderated by accountability, communication, engagement, and responsiveness within the service network.Research limitations/implicationsBy uncovering causes of imbalance in complex public service networks, this paper pinpoints important research avenues for developing the balanced centricity perspective.Practical implicationsThe inherent existence of multiple parallel institutional arrangements makes networks imbalanced, but value creation can be achieved when the appropriate mechanisms are fostered to manage balance between divergent logics.Originality/valueBy examining imbalance as the underlying cause of network dysfunction, this research contributes to understanding of the dynamics in, and performance of, complex public service networks.

15 Years of Whistleblowing Protection under the Public Interest Disclosure Act 1998: Are We Still Shooting the Messenger?

Abstract In the wake of high-profile scandals such as the catastrophic failings of the Mid-Staffordshire National Health Service Trust, this article contributes to the debate on the role of the Public Interest Disclosure Act 1998 (PIDA), now 15 years in force, in promoting increased transparency in the workplace. The article briefly discusses legal protection for whistleblowers prior to the PIDA before proceeding to evaluate the development of the provisions through judicial decisions. The article considers the implications of the amendments effected by the Enterprise and Regulatory Reform Act 2013, namely the public interest and good faith requirements, protection from detriment by a co-worker and extension of the ‘worker’ category. In drawing on quantitative and qualitative data, the article highlights the frequent disparity between an organisation’s ‘party line’ and the cultural reality of the workplace. The article explores the difficulties inherent in evaluating the success of legislation, which essentially aims to change attitudes in the workplace, but contends that the PIDA continues, albeit incrementally, to move towards its intended purpose.

Reflections on learning and teaching medical ethics in UK medical schools

The development of learning, teaching and assessment of medical ethics and law over the last 40 years is reflected upon with particular reference to the roles of the London Medical...

Embracing external scrutiny to build bridges and genuine partnerships between education and clinical practice

Despite having made significant changes and improvements since 2007, publication of The Mid-Staffordshire National Health Service Foundation Trust Public Inquiry (2013) refocused attention on the poor care standards that had taken place. Recommendations include far reaching national transformational changes not only for the National Health Service but also for professional regulatory bodies and other agencies linked to health and social care. This paper describes how external scrutiny was embraced to move staff from initial loss of confidence, feelings of anger and defensiveness to embracing opportunities to increase transparency, build bridges and genuine partnerships between universities and healthcare providers. Following an Extraordinary Review by the Nursing and Midwifery Council an action plan was collaboratively formulated between Staffordshire University and Mid-Staffordshire National Health Service Foundation Trust. This resulted in the implementation of a Practice Learning Improvement Project which monitored the action plan, ensured sharing of all learning and production of evidence for external scrutiny. Key lessons learnt included the need to: move beyond mere compliance with regulatory performance indicators; engage senior staff in all aspects of student learning; develop candid sharing of soft and hard intelligence, clearly delineate placement support roles and ensure engagement of academics in practice has transparent outcomes for the student, practice and education.

Implications of the Francis Inquiry for mental health research

The Francis Inquiry1 into failings in care at Mid Staffordshire National Health Service (NHS) Foundation Trust is seen by many as the most important event in recent NHS history. The inquiry was not about mental health or about research, but its influence on both will nevertheless be far-reaching. From the 1782 pages and 290 recommendations of the inquiry, several over-riding themes stand out, and these themes are likely to resonate through all areas of the NHS, the wider care system, and reach clinical research, including those who fund or host it.

Are theoretical perspectives useful to explain nurses' tolerance of suboptimal care?

This paper explores two theoretical perspectives that may help nurse managers understand why staff tolerate suboptimal standards of care. Standards of care have been questioned in relation to adverse events and errors for some years in health care across the western world. More recently, the focus has shifted to inadequate nursing standards with regard to care and compassion, and a culture of tolerance by staff to these inadequate standards. The theories of conformity and cognitive dissonance are analysed to investigate their potential for helping nurse managers to understand why staff tolerate suboptimal standards of care. The literature suggests that nurses appear to adopt behaviours consistent with the theory of conformity and that they may accept suboptimal care to reduce their cognitive dissonance. Nurses may conform to be accepted by the team. This may be confounded by nurses rationalising their care to reduce the cognitive dissonance they feel. The investigation into the Mid Staffordshire National Health Service called for a change in culture towards transparency, candidness and openness. Providing insights as to why some nursing staff tolerate suboptimal care may provide a springboard to allow nurse managers to consider the complexities surrounding this required transformation.

Doctors and others: reflections on the first Francis Report

In 2009, the Healthcare Commission identified numerous excess deaths in the Mid Staffordshire NHS Trust (Mid-Staffs) between 2005 and 2008. This led to the inquiry by Robert Francis QC (hereafter, ‘Francis Report’), published on 24 February 2010.[1][1] Mid Staffordshire National Health Service (