“I have been so depressed by this experience that I have often considered suicide…. I have lost all faith in the NHS and the employment tribunal system”
Candour is the foundation of a healthy culture.
The overriding culture of an organisation can be measured in the ease – or tension – of daily conversations.
It’s easy for leaders to say “We need a culture of ethics” but hard to do.
To make it so, a simple code of principles is far more useful than complex rules.
When rules and compliance take over, candour is the first casualty. That’s when ethics starts to go wrong.
The cultural symptoms are easy to spot. People look over their shoulder, ‘doing the right thing’ becomes ‘doing what I’m told and not thinking for myself’. Blame, control, fear take over. Inertia sets in. People are suspicious, the maverick voice is isolated, a mania of Cc-ing emails.
In a culture of principles rather than rules, something different happens. Within a shared belief of what we stand for, it’s easier to open up. People feel permission to ask the tricky questions, confident that this is helpful not risky.
Candour comes when it is demonstrated to be safe and open, that sensitive matters can still be discussed in a common sense way. It’s ordinary, everyday.
Candour becomes normal, part of ‘how we do things’. That’s why values need to be active – not just a list of words on a wall. In cultures based on rules and regulation candour closes up. And, as the NHS has seen, this will cause a whole lot more ethical risk than it prevents.
Francis calls for a culture in which
“Speaking up about what worries them is a normal part of everyone’s routine”
A culture of principles leads to candour and commitment: compliance leads only to control or censure.
The foundation is the basis of belonging: purpose (what we’re here for) and ethos (what we stand for).
On top of this, the principles Francis has outlined allow openness and candour to flourish.
This sets the context, so that code of conduct, or policies for specific roles, can be more easily observed.
The new recommendations, which the health minister has committed to taking seriously, include:
- All staff feel safe to raise their concerns
- Leaders to demonstrate that they encourage raising concerns
- Chance for reflection on learning from experiences and how to improve
- Guardians for whistleblowers and those who want to speak up
This is relevant to any organisation, far beyond the specific context of the NHS.
Francis conducted a comprehensive study of experiences across the NHS, getting right to frontline. He stresses the need for informal exchange, early in concerns, rather than reliance on structure and bureaucracy. This resonates with what I’ve seen in many organisations recovering from regulatory ethical contravention or prosecution.
He acknowledges many examples of great practice and stresses that it’s not just whistle blowing or raising issues that matters:
“My review also brought home to me how challenging it can be to receive concerns – issues can be difficult and sensitive to solve”
And of course, like healthcare, ethical prevention is better than cure.
If you have to blow the whistle it’s already too late.
That’s why freedom to speak up is so critical.
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