Whistleblowing in the Australian public hospital system

To the Editor: Three recent articles in the MJA about complaints by patients attending hospital, 1 attitudes of hospital staff toward incident reporting2 and whistleblowing3 show that complaints are common, that cultural change is needed to allow staff to understand that a complaint from a patient or staff member should be viewed as an opportunity for change, and that quality assurance sometimes relies on whistleblowers but does not always appreciate their efforts.

Faunce and Bolsin report on three whistleblower incidents,3 but fail to mention one at the Royal Children’s Hospital, Melbourne, in which I was involved. Attempts to highlight deficiencies in delivery of paediatric surgical care and concerns about the response to adverse events were managed with threatening tactics (of dismissal) by the division of surgery. This was followed by a hospital board investigation that, in my opinion, had neither the skill mix nor the terms of reference to adequately investigate the quality of care or the bullying. The subsequent investigation by the Department of Human Services involved narrowly focused terms of reference and failed to consider outcomes in some circumstances, thereby facilitating the “shooting of the messenger”.

Current legislation does not effectively allow for dealing with threatening behaviour in the workplace, particularly when the refusal to look at complaints and adverse events in a productive manner goes well beyond the confines of the hospital involved. The Community Advisory Committee parliamentary enquiry was held in camera, with evidence being kept from the public. Worksafe legislation on bullying does not deal well with the complex situations that arise in the healthcare industry.4

The Colleges and other professional bodies, such as the AMA and the Medical Boards, need to take a proactive rather than a reactive role if further whistleblower incidents are to be avoided.

I concur with the statement of Faunce and Bolsin that: “Even after substantiation of their allegations, the whistleblowers . . . received little respect and support from their institutions or professions”.3 From personal experience, I am very aware of the lack of support that stems from an ethos wary of public criticism, and the reactive bullying to which the whistleblower is often subjected.

Until the culture of healthcare focuses on quality and caring, whistleblower sagas will continue to occur.