In the age of Lean, why are health care providers telling their workers to shut up?

As a public sector union we are often left to speak for those who can’t. Members often face reprisals and discipline from their employer if they speak publicly about problems in public service delivery for which they have first-hand expert knowledge.

When they feel they cannot speak out, we all lose as both funders and users of these services.

Badly run organizations often go hand-in-hand with a culture of fear among employees. This was a lesson learned at Windsor’s Hotel Dieu hospital, where a dysfunctional staff culture led to major issues and incidents around quality of care for patients.

Supervisor Ken Deane (now the CEO) specifically noted that among management there was a culture of “fear of reprisal for speaking up” at Windsor Hotel Dieu.  Just imagine what it would be like to be a front line worker.

The irony of such workplaces is not lost on us amid all the talk about empowering front line workers through such continuous quality improvement processes as Lean. It also calls into question the government’s commitment to transparency and accountability when front line staff are effectively gagged.

At a recent Insight Conference, health care administrators varied in their response to Lean – some continue to be enthusiastic boosters while others found it time consuming and hard to sustain. Others lamented the front line support staff were being left out of the process – a fatal flaw given insights they gain from direct contact with patients. There is no question that the culture of an organization is going to be key to whether such processes actually work. It is important to note that the dysfunctional Windsor Hotel Dieu had already implemented Lean.

When workers cannot find a voice in their workplace, they turn to the union. When the union finds it is not being listened to, frequently we turn to the public (such as in this BLOG). There is no greater disinfectant than public scrutiny.

The issue of employees speaking to the media has come up recently at the Wellington Waterloo Community Care Access Centre, which is opening its board meeting to public input tentatively on October 24th. The WWCCAC is being called upon to review a media clause in the Ontario Association of Community Care Access Centre contract templates with contract home care agencies that forbid any employee of that agency speaking to the media about CCAC services without advanced approval from the CCAC.

Activist David Williams, who is urging local community members to attend the WWCCAC meeting, notes in his flyers that the gag clause has allowed the CCAC to misrepresent facts in the media without the contract agencies being able to respond. This, he says, “prevented our community from learning information about changes to service delivery that it deserved to know.”

At Ontario Shores Centre for Mental Health Sciences a staff member was given a three-day suspension for sharing over his private dinner conversation an incident that took place at the mental health hospital. No patient confidentiality was breached with his spouse (the story came back around when his spouse repeated the story in a private conversation elsewhere). This strikes us as completely over the top in the hospital’s attempt to bolster a crumbling public image – and perhaps not entirely coincidental to recent public disclosure on this BLOG.

A few years ago we had a conversation with a senior LHIN employee over issues on this BLOG. We asked him why he didn’t simply post a reply? The whole point of our BLOG is to create a discussion. He felt he couldn’t in his role with the LHIN.

If the Minister of Health really wants to improve health care, she should take off the gag, improve whistleblower protection, and open hospitals and other health care providers up to the scrutiny of the Ontario Ombudsman. Ontario is the only province where the ombudsman does not have jurisdiction over public hospitals.

If nobody else will listen, likely the Ombudsman will.

The Minister should also tell the CCACs – a creature of government – to get rid of that stupid clause. It’s about time.

And if you want to leave a reply, please do so no matter who you are. Comments are vetted, but only for issues of libel or comments that may be taken as bullying other readers (such as name calling).