As professional regulator, the General Dental Council (GDC) has a duty to encourage dental professionals to raise concerns where they have witnessed something that they believe poses a risk to patients. The Report into the Mid Staffordshire NHS Foundation Trust Public Inquiry (the ‘Francis Report’) highlighted numerous issues relating to the provision of health services, not least the fact that taking the decision to raise a concern in the workplace is often a difficult one, which may impact on health professionals’ personal and professional lives. One objective of the GDC’s response to the Francis Report was to review its guidance for registrants on raising concerns, to ensure it demonstrates a commitment to an open and transparent culture and to remove any perceptions that whistleblowing will be treated as a fitness to practise issue.

 

Research approach
GDC, therefore, commissioned Community Research to conduct a piece of research which would enable it to:

  • identify the barriers and enablers which affect registrants who want to raise concerns
  • provide clear guidance/advice for registrants who may want to raise a concern, taking into account the identified barriers and enablers
  • ensure that the GDC’s internal processes enable it to deal effectively and efficiently with registrants when they raise concerns, taking into account the identified barriers and enablers

A two-stage qualitative approach was adopted; 36 in-depth telephone interviews with dental professionals were conducted initially, followed by an online bulletin board with the same participants. The bulletin board acted as a platform for open discussion and iterative debate of issues and ideas raised during the telephone depth interviews. Clearly the issues for exploration were extremely sensitive and personal and some debate was had about the optimal approach. The chosen methodology provided the best of two worlds: an anonymised forum for discussion whilst still enabling detailed feedback at an individual level.

Findings
A significant finding of the research was that while there is a general overarching awareness of the standards amongst dental professionals, there is a mixed understanding of their obligations to raise concerns, as set out in the standards. Those participants who were recently qualified, working in training and hospital environments or who generally took a more proactive interest in their own development were found to have more awareness than others. Older registrants were more likely to regard raising a concern as a matter of ‘common sense’ rather being something prompted by knowledge of GDC.

Raising concerns is felt to be more prominent now than in the past, popular reasons for this included the introduction of registration of dental care professionals (in addition to dentists), a societal shift towards a blame culture, and an increased focus on professional training.

Barriers to raising concerns were categorized under four loose headings:

1) Broad cultural and systemic barriers – cultural workplace issues, stigmas and the broader health system
2) Workplace barriers – structural and processing issues and workings relationships, variable workplace settings.
3) Personal barriers – experience, doubts over validity, fear of repercussions and loyalty to peers.
4) Process barriers – inadequate policies and procedures, lack of knowledge of such procedures.

Both individual and environmental factors were described as having an impact on professionals’ approach to raising concerns. On one hand, an individual sense of ethics was identified as a considerable driver for reporting concerns. However, when it came to identifying and dealing with issues, some felt that in dental practice settings, grey areas and autonomous decision-making clouded the ability to define and approach issues with clarity. This was in contrast to those in hospital settings who felt they had clearly defined processes to deal with concerns.

The major enablers to encourage raising a concern, and areas for improvement were related to workplace culture in terms of management, improving systems and procedures, and staff recognition. More training and guidance, and peer-to-peer mechanisms for feedback were also discussed. In terms of the GDC, some participants identified improvements to the Fitness to Practise process as an important solution. The most popular suggestion for a solution was the introduction of an anonymous helpline, which could be engaged prior to raising a concern formally.

Next steps
Using the insight gained from this research with registrants, the GDC will review and publish updated guidance for registrants on raising concerns. The GDC will also use the evidence gained through this research to explore if and how it can improve its own internal processes for dealing with registrants who raise concerns to them, to ensure they are as effective as possible in safeguarding patient safety. The findings also suggest there may be a need for a more standardised approach and framework for raising concerns, in which registrants can operate to comply with their registration requirements.

The full research report and a summary can be found here.

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