This week I’ve been reading an article from the Harvard Business review about the Psychology behind unethical behaviour. They identify three setting conditions for corporate unethical behaviour to take place. Omnipotence, Cultural Numbness and Justified Neglect. The article targeted those in the financial or business world. We would argue that the article is just as applicable to Health and Social Care.
In all organisations there are those with and those without power. The power doesn’t always come with a title and often in care, those with power, are staff who’ve been there the longest. This can lead to organisations relying on staff who’ve been there longer to “run things”. These staff are very often excellent carers with ethical leadership skills. Frequently, those excellent leadership skills arise from their ability to manage crisis situations. That’s good if they manage crisis situations ethically. Leadership skills that arise from controlling those in care, creates a problem. This leadership style was noticeable in the Winterbourne View scandal. In Chapter one of the Timian Programme, we discuss empowering those we support. This means giving up some power yourself.
Cultural Numbness arrives in very small steps. The first step is adopting language which can dehumanise those being supported (Marsland et al., 2015). Reducing the people to their behaviour (he’s a hair puller), or their diagnosis (we’ve got one autistic). Including different rules for staff and those they support (Marsland et al., 2015) is yet another step. In services with high levels of behavioural crisis, staff often become immune to incident management. A video of an eight year old boy being arrested in Florida was recently released. Allegedly, when he struck a teacher, the police were called. When the police arrived, he was arrested and handcuffed . Although many were shocked, others appeared to think this was an appropriate response. This approach to managing a child in crisis is the antithesis to our trauma informed programme.
In the absence of clear guidance, or clear protocols, we will see more justified neglect. Staff who are unsure of what course of action to take in crisis, may listen to unethical guidance from those in power. The rationale used is that they want to keep in a person’s good books. Whatever the reason, we might think they have control over your job, they might have control over your shift patterns, they may be a powerful and vocal member of staff who will make your life difficult if you speak out. This allows the unethical behaviour to continue and in many cases thrive, which in turn leads to cultural numbness. In chapter three of the Timian Programme, we look at developing strategies that give clear guidance on what to say and do based on the individual you’re supporting.
Checks and Balances
In Health and Social care there are supposed to be checks and balances to ensure we don’t have instances of abuse. This is why in Timian, we believe that every training organisation should be delivering a module around Core Values that supports restraint reduction. This won’t eliminate the problem of unethical behaviour. But, if your training in crisis management, restraint or managing behaviour doesn’t address your core values or restraint reduction, then it will almost definitely increase the potential for harm. Most of the organisations we’ve worked in partnership with throughout the years have strong core values. They do this through constant examination of their approach and questioning their strategies. They ensure that they, like us, believe that all people should be able to say.
In this place and with these people, I feel safe.
Dave Marsland, Peter Oakes and Caroline White ‘Abuse in care? A research project to identify early indicators of concern in residential and nursing homes for older people’ Journal of Adult Protection 7(2,2015) p.111-125