PADM505 LESSON 8 ETHICS OF DISSENTIntroductionTopics to be .docx

PADM505 | LESSON 8: ETHICS OF DISSENT
Introduction
Topics to be covered:
· Whistleblowers
· Ethics of Dissent
All government employees, from the President of the United
States down to the lowest level public administrator in a local
government, are accountable to the citizens they serve, and they
have a responsibility to conduct governmental affairs in a
manner that meets citizens’ expectations. This includes
performing their work in a manner that is transparent and
accountable. There may come a time when a public
administrator will need to oppose those in power to do that.
Bob Woodward or “Deep throat” comes to mind when we think
of individuals who “blew the whistle” on their governmental
agency. Daniel Ellsberg leaked the Pentagon Papers. There have
been more in recent years such as Bradley Manning and Edward
Snowden.
Whistleblowers
STEPS TO TAKE If an individual feels that he or she should
become a whistleblower, the National Whistleblower
Center (NWC) provides information and resources on the
process. If someone decides to pursue whistleblowing, some of
the steps he or she should take include the following:
· Check legal guidelines for whistleblowing. For example, the
Occupational Safety and Health Administration (OSHA) has
guidelines that should be followed in the process.
· Gather information and evidence to document the wrongdoing
that the whistleblower is reporting.
· Hire an attorney experienced in whistleblowing cases to offer
support and guidance in the process. Work with that attorney to
build a case.
· Legally, whistleblowers have the right to remain anonymous.
But in reality, whistleblowers are often identified, even if they

take actions intended to maintain their anonymity. As such,
whistleblowers should prepare for the backlash that may occur
if others find out that they reported wrongdoing. As part of this
preparation, whistleblowers should consider getting another job.
If they do this, they should change jobs before their case
becomes public.
LEGAL RIGHTS AND RETALIATION Whistleblowing is a
legal right, and whistleblowers at the federal level of
government are protected by law under the Whistleblower
Protection Act of 1989. If an employer retaliates against an
employee or other individual for being a whistleblower, that
person can file a complaint. Some of the laws that include
protection for whistleblowers include the following (United
States Department of Labor, n.d.):
· Clean Air Act
· Comprehensive Environmental Response, Compensation and
Liability Act
· Consumer Financial Protection Act
· Energy Reorganization Act
· Federal Railroad Safety Act
· National Transit Systems Security Act
· Surface Transportation Assistance Act
· Sarbanes-Oxley Act
· Toxic Substances Control Act
Be sure to explore the statutes that govern the procedure for
whistleblower protection.
In addition to federal laws, many states also have laws that
offer protections to government employees who become
whistleblowers. According to the NCSL’s website, the states
that have such laws include Alabama, Alaska, Arizona,
California, Colorado, Connecticut, Delaware, Florida, Hawaii,
Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine,
Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New
Hampshire, New Jersey, New York, North Dakota, Ohio,
Oklahoma, Oregon, Pennsylvania, Rhode Island, South
Carolina, Tennessee, Utah, Washington, and West Virginia.

Generally, these laws prohibit retaliation against employees and
others who become whistleblowers, and they impose fines and
other sanctions against anyone who engages in retaliation.
Many local governments also include legal protections for
whistleblowers. For example, in Miami-Dade County, Florida,
individuals who become whistleblowers and experience
retaliation can file a complaint with the county’ Ethics
Commission. If the Commission determines that retaliation has
occurred, this will be regarded as a violation of the
county’s Conflict of Interest Ordinance (Commission on Ethics
and Public Trust, Miami-Dade County, n.d.). Retaliation occurs
when someone takes action to seek revenge against another
person who has aggrieved them in some way. Some common
methods of retaliation against government employees who
become whistleblowers include salary reductions, demotions,
and suspensions.
·
WHISTLEBLOWERS Thus far, this course has
recommended that to ensure public administrators are ethical,
governments at all levels need to hire ethical employees, have
leaders who practice ethical leadership, establish ethical
organizational cultures, and have guidance for ethical behavior
in laws and other directives, including codes of ethics.
There is another way to promote ethical behavior among public
administrators: whistleblowing. A whistleblower is someone
who notifies authorities to report activities in the workplace
that are illegal, unethical, or wrong for some other reason.
Whistleblowers exist in both the public and private sectors.
Public administrators at all levels of government have the
option of becoming whistleblowers if they feel a situation
warrants whistleblowing. A whistleblower does not necessarily
have to work for the organization where misconduct occurs. If a
contractor, vendor, client, or other individual who has contact
with any business or government organization gains knowledge
of activities that he or she is concerned may be illegal,
unethical, or wrong for any other reason, he or she has the right

to become a whistleblower and report the activities. Such
activities may include the following:
· Violations of federal, state, and/or local laws.
· Malfeasance, which refers to any activity, such as theft, that is
clearly illegal and wrong.
· Misfeasance, which refers to a transgression that occurs in the
process of exercising legal authority. This generally occurs
when an individual with authority misuses or abuses that
authority. For example, if a manager uses his or her position to
secure a job for an unqualified friend, this is misfeasance. In
another example, misfeasance occurs if an attorney repeatedly
misses deadlines, creating problems for a client’s case.
· Nonfeasance, which is the failure to take action that is
required by law.
· Using public resources in a way that is inefficient and
wasteful.
Explore the US Dept of Labor’s Whistleblower’s Protection
Programs webpage for more detail.
Ethics of Dissent
In 2014 the Supreme Court decided Lane v Franks, 570 US ___
(2013). (If you are not familiar with Supreme Court opinions,
you will see the summary at the link provided above. But don’t
stop there. Click on the oral opinion and you can hear the
arguments before the court. Below that is the full transcript.)
Lane was hired into a temporary position at Central Alabama
Community College. In that position, he terminated the
employment of an individual who was on the payroll but did not
actually work at the organization and testified against her in
court. The president of the community college fired Lane along
with others but hired many of the others back. Lane sued on the
theory that he was fired in retaliation for testifying against the
earlier individual which was a violation of his First Amendment
rights. The Supreme Court held that Lane did testify, not as a
condition of employment, but as a citizen, therefore, his speech
was covered under the First Amendment. However, the claim
was dismissed because the president had qualified immunity.

To understand more about why qualified immunity protected
the president, click on the link.
What examples can you think of where dissent was an ethical
choice in the park of the dissenter? Do citizens have the
obligation to dissent if their government is doing something
unethical? Who determines what is unethical? Is public opinion
the final say? Can protests and peaceful demonstration change
the actions of government administrators? Keep these very
difficult questions in mind as you continue your studies in
public administration.
Conclusion
Dissent is not always negative. At times, dissent by either
administrators or citizens produces beneficial results. Legal
protections exist for whistleblowers, but the process can still be
daunting. Despite this, whistleblowing is sometimes a public
service if it is the only practical way to put a stop to illegal
and/or unethical activities that are routinely occurring in a
government organization or agency.
References
Commission on Ethics and Public Trust, Miami-Dade County.
(n.d.). Ethics Rules and Ordinances. Retrieved November 15,
2017, from http://ethics.miamidade.gov/ordinances.asp
Lane v. Franks. (n.d.). Oyez. Retrieved November 15, 2017,
from https://www.oyez.org/cases/2013/13-483
National Archives. (n.d.). Pentagon Papers. Retrieved
November 15, 2017, from
https://www.archives.gov/research/pentagon-papers
National Conference for State Legislatures (NCSL). (2010,
November 19). State Whistleblower Laws. Retrieved November
15, 2017, from http://www.ncsl.org/research/labor-and-
employment/state-whistleblower-laws.aspx
National Conference of State Legislatures (NCSL). (2017).
“Ethics in the News 2017.” Retrieved from
http://www.ncsl.org/research/ethics/ethics-in-the-news-
2017.aspx.

National Whistleblower Center. (n.d.) Retrieved from
http://www.whistleblowers.org/
National Whistleblower Center. (n.d.). Retrieved from
www.whistleblowers.org/resources/the-whistleblowers-
handbook.
Robson, Ruthann. (2014). Opinion analysis: First Amendment
clearly protects public employee’s subpoenaed testimony – but
not sufficiently clearly to overcome qualified immunity.
SCOTUSblog. Retrieved from
http://www.scotusblog.com/2014/06/opinion-analysis-first-
amendment-clearly-protects-public-employees-subpoenaed-
testimony-but-not-sufficiently-clearly-to-overcome-qualified-
immunity/
United States Department of Labor. (n.d.). Statutes. Retrieved
from https://www.whistleblowers.gov/statutes
United States Department of Labor. (n.d.). The Whistleblower
Protection Programs. Retrieved from
https://www.whistleblowers.gov/
Running head: SAFETY SCORE IMPROVEMENT PLAN 1
Copyright ©2017 Capella University. Copy and distribution of
this document are prohibited.
Safety Score Improvement Plan for TrueWill General Hospital
Learner’s Name
Capella University
Organizational and System Management for Quality Outcomes

Safety Score Improvement Plan
May, 2017
SAFETY SCORE IMPROVEMENT PLAN 2
Safety Score Improvement Plan for TrueWill General Hospital
Nursing professionals are key players in maintaining a culture
of quality care and patient
safety in a health care environment. Their role in addressing
specific patient safety issues will be
discussed using the example of TrueWill General Hospital
(TGH), a 1,500-bed multispecialty
hospital in the United States. The hospital regularly reports its
performance data to the Hospital
Safety Score, a nongovernmental organization that ranks
hospitals on their safety rate.
The safety score for the orthopedic inpatient unit of TGH has
alarmingly increased

because of the number of patient injuries resulting from falls.
The negative score can affect the
image of the hospital, because patient falls are preventable
hospital-acquired conditions. The
nurse manager of the unit has been advised by the hospital’s
patient safety office to identify the
cause of the problem, determine an evidence-based safety score
improvement plan, and devise
measurable long-term solutions for the safety issue.
Factors behind the Patient Safety Issue
Patient falls are one of the most reported patient safety
incidents in health care practice.
According to the American Nurses Association (n.d.), it is a
serious problem in nursing and
health care; as injuries resulting from falls can lead to
permanent loss of function of certain body
parts or even death. According to systems theory, adverse
events such as patient falls are related
to the quality of care provided by health care professionals at
the front line of operations such as
nursing professionals (Lawton, Carruthers, Gardner, Wright, &
McEachan, 2012).
Health care experts have relied on systems theory and systems
thinking perspectives to

analyze the incidence of safety issues as a nursing challenge.
The theory states that problems in
any part of a system, such as the nursing department in a
hospital, will affect the functioning of
Comment [A1]: Yes, patient falls
and how can lead to adverse effects,
even death.
the hospital as a whole. Therefore, larger organizational
systems should be taken into
consideration while implementing changes in nursing profession
to improve safety issues.
Influence of Leadership in Changes for Safety
Nurse leaders at TGH are an important systems factor in driving
changes at the
organizational and clinical level. The importance of leadership
in achieving better patient
outcomes or patient experiences was explored in a study of
leadership practices and styles

(Wong, Cummings, & Ducharme, 2013). The study showed that
relational leadership styles,
which focused on people and relations, improved patient
outcomes because nurse leaders were
able to assess patients’ needs better and coordinate staff and
resources accordingly (Wong et al.,
2013).
TGH nurse leaders can use relational leadership styles to
analyze the systems effect of
safety issues on patients and nursing professionals. The
leadership style can improve job
satisfaction among nursing professionals by better managing
staff and can enhance patient safety
and satisfaction by providing quality care. Relational nurse
leaders are also able to effectively
use systems theory to analyze organizational policies and
procedures that impact patients directly
and affect the way nursing professionals deliver care.
The Effects of Policies and Procedures on Safety Issues
Policies and procedures govern every aspect of nursing such as
management of staff,
modes of health care delivery, and fiscal and material resources.
When applied to policies and

procedures governing staff management, systems theory helps
nurse leaders assess the
competencies of their nursing professionals, plan staff
schedules to prevent work overload, hire
more nurses to address shortages, and introduce strategies to
retain current nurses.
Comment [A2]: Yes, patient
centered care.
The dynamic systems model, a systems-theory-based model, can
help nurse leaders
monitor and reassess those policies (Morath, 2011). It promotes
a transparent health care system
where nurses are trained to (a) provide transparent care, (b)
anticipate and pullback from risky
practice, (c) work with other health care professionals, (d)
monitor peers, and (e) be innovative
and open to new technology that tests and studies safety
practices. The model requires nurse

leaders to research potential safety issues and gather evidence
about those issues before
implementing specific changes.
Recommendations to Ensure Patient Safety
Introducing changes for patient safety starts with collecting
information, which will
ensure an evidence-based approach to solving problems. The
data collected will help devise a
safety improvement plan. A structured approach to
organizational change is important if the plan
is to be properly implemented.
The root cause analysis (RCA) is a systematic analysis of the
common causes of safety
issues. The RCA also devises strategies to prevent future safety
incidents. Based on systems
theory, the techniques of the RCA move beyond individual
blame for clinical errors and examine
the organizational factors that contribute to the errors (Huber,
2017; Dolansky & Moore, 2013).
According to Dolansky and Moore, all nursing professionals
must know how to conduct
the RCA as it teaches them about systems theory. However,
there are difficulties in obtaining

information for the RCA. Teams that conduct RCAs often
overlook important evidence in the
care process in their hurry to complete the analysis before the
stipulated 45 days set by the Joint
Commission (Wocher, 2015). The lack of information can
impede strategies for implementing
evidence-based changes in safety.
Evidence-based Strategy to Improve Patient Safety
Comment [A3]: The model
promotes…
Comment [A4]: Reference?
Comment [A5]: Good inclusion of
QSEN, to improve include limitations
of the strategy.
Competency development integrated into staff management is a
proven strategy in

improving patient outcomes. One evidence-based education plan
that can be adapted to clinical
practice is the Quality and Safety Education in Nursing (QSEN)
initiative. Funded by the Robert
Wood Johnson Foundation, the competencies of the QSEN
integrate quality improvement and
safety management into nursing education (Dolansky & Moore,
2013).
With the QSEN’s background in systems theory, nursing
professionals can apply it at the
individual and organizational levels of care. The six
competencies of the QSEN are as follows:
(a) patient-centered care, (b) evidence-based practice, (c)
teamwork and collaboration, (d) safety,
(e) quality improvement, and (f) informatics (Dolansky &
Moore, 2013). Nursing professionals
who develop these competencies are better able to deliver safe
care and solve safety issues.
However, there are limitations to the QSEN strategy. The QSEN
is more than a decade
old and has not been updated. Despite these difficulties, the
QSEN competencies have become a
key component of quality care and patient safety.
Plan to Implement Safety Recommendation and Monitor

Outcomes
The education department teaches staff to think like systems
thinkers and develop
personal mastery over the profession and system (Burke &
Hellwig, 2011). The education
department at TGH could integrate QSEN competencies into
education programs using a
framework for organizational learning called the Baldrige
framework. A system of continuous
quality improvement, the Baldrige framework explains seven
criteria that are indicators of
quality for organizational learning programs: (a) leadership; (b)
strategic planning; (c) focus on
patients, other customers, and markets; (d) measurement,
analysis, and knowledge management;
(e) workforce focus; (f) process management; and (g)
organizational performance results (Burke
& Hellwig, 2011; Huber, 2017). Educational outcomes can be
monitored at two levels: (a) the
Comment [A6]: Need to elaborate a
little more about accountability of
staff.

systems level where organizational performance is reviewed
through patient and customer
satisfaction surveys, scorecards, and human resources
indicators; and (b) at the departmental
level through pre- and post-testing of nursing professionals,
course evaluations, further training
of select nursing professionals, and assessments.
The improvement of safety standards at TGH starts with
developing the competency of
its nurse leaders and nursing professionals. Because nursing
professionals are at the front lines of
care delivery, nurse educators should tailor programs, content,
and goals to suit the unique needs
of the nursing profession.
Conclusion
Patient safety issues such as patient falls are commonplace in a
health care organization.
Health care professionals must develop the foresight and
strategic thinking to identify patient

safety issues early and have solutions at the ready. The example
of TGH shows the importance of
preemptively addressing safety issues in nursing instead of
letting them fester over time and
affect organizational performance. TrueWill General Hospital
and its leadership should take an
active interest in developing nursing competencies
continuously, focusing on quality and safety
education. Embedding these ideas into the safety score
improvement plan will create a lasting
culture of quality care and patient safety. These are the
standards that define the organization’s
image in health care.
Comment [A7]: Good!
References

American Nurses Association. (n.d.). Patient Falls. Retrieved
from
http://ana.nursingworld.org/qualitynetwork/patientfallsreduction
.pdf
Burke, K. M., & Hellwig, S. D. (2011). Education in high-
performing hospitals: Using the
Baldrige framework to demonstrate positive outcomes. The
Journal of Continuing
Education in Nursing, 42(7), 299–305.
https://dx.doi/10.3928/00220124-20110103-01
Dolansky, M. A., & Moore, S. M. (2013). Quality and safety
education for nurses (QSEN): The
key is systems thinking. OJIN: The Online Journal of Issues in
Nursing, 18(3).
https://dx.doi/10.3912/OJIN.Vol18No03Man01
Huber, D. L. (2017). Leadership and nursing care management
(6th ed.) Philadelphia: W.B.
Saunders. http://dx.doi.org/10.7748/nm.21.6.13.s14
Lawton, R., Carruthers, S., Gardner, P., Wright, J., &
McEachan, R. R. C. (2012). Identifying the
latent failures underpinning medication administration errors:
An exploratory
study. Health Services Research, 47(4), 1437–1459.

http://dx.doi.org/10.1111/j.1475-
6773.2012.01390.x
Morath, J. (2011). Nurses create a culture of patient safety: It
takes more than projects. Online
journal of issues in nursing, 16(3).
https://dx.doi/10.3912/OJIN.Vol16No03Man02
The Joint Commission. (2015). Root cause analysis in health
care: Tools and techniques (5th
ed.). Retrieved from
http://jcrinc.com/assets/1/14/EBRCA15Sample.pdf
Tomlinson, J. (2012). Exploration of transformational and
distributed leadership. Nursing
Management, 19(4), 30–34.
http://dx.doi.org/10.7748/nm2012.07.19.4.30.c916
Wocher, J. C. (2015). The importance of a rigorous root cause
analysis (RCA) for healthcare
sentinel events. Japan-hospitals: The Journal of the Japan
Hospital Association, 34, 23–

27. Retrieved from
http://hospital.or.jp/e/pdf/13_20150700_01.pdf#page=26
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The
relationship between nursing
leadership and patient outcomes: A systematic review update.
Journal of nursing
management, 21(5), 709–724.
https://dx.doi/10.1111/jonm.12116

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