The art and science of gossip: Rethinking evidence-based management in healthcare

Kathryn Waddington, PhD

Psychologist at the University of Westminster, United Kingdom

The art and science of gossip: Rethinking evidence-based management in healthcare

29 October 2020

Quick Takes

  • Gossip can be a valuable early warning indicator of risk and failure in healthcare systems

  • There is potentially significant value in re-framing gossip as an aspect of organizational communication and knowledge

  • If attended to – rather than neglected or silenced – gossip can provide fresh insights into professional practice, decision making and healthcare leadership

Acknowledgements

I would like to thank the following colleagues whose conversations and reflections have informed the practical and actionable advice shared here for rethinking evidence-based management in healthcare.

  • Shade Alu – Consultant Paediatrician, Croydon NHS Trust and Designated Doctor for Safeguarding Children and Child Death Reviews
  • Dean Fathers – Former Chair, Nottinghamshire Healthcare NHS Foundation Trust
  • Annie Topping – Professor of Nursing, University of Birmingham

The potential power of gossip to improve healthcare 

Gossip – something to be avoided, dismissed or eliminated – or something worth thinking about when it comes to evidence-based management in healthcare? Government-led inquiries, or investigations, illustrate the stark human, financial, and reputational costs of healthcare failure. They also reveal that information about the antecedents of failure and scandal are often “common knowledge” contained in gossip. For example, the UK Kerr/Haslam inquiry1 into the sexual abuse of psychiatric patients asked:

  • How could it happen that abuse of patients, evidenced by the convictions of William Kerr and Michael Haslam, went undetected for so long?
  • How could it be that the voices of the patients and former patients of William Kerr and Michael Haslam were not heard?
  • Why were so many opportunities to respond and investigate missed?

The report illustrated how detection, and more importantly prevention, of patient safety failures may depend on how organizations react to rumour or gossip. The financial cost to the British taxpayer of the Kerr/Haslam inquiry in 2005 was £3.2m. In 2013, the Mid-Staffordshire inquiry into failures of hospital care cost UK taxpayers £19.5m. The stories of patient mistreatment at Stafford Hospital have become notorious – patients and their families reported dirty wards, a lack of nursing care, and long waits for medical attention2. Many suffered horrific experiences that will haunt them for the rest of their lives. The human costs to patients and their families of failures in hospital and clinical care are tragic and immeasurable. 

I have found that talking about my research into the role and function of gossip in healthcare organizations3 has often provided a catalyst for clinicians and healthcare leaders to think differently about gossip. For example, a senior nurse commented:

Having read your work Kathryn, now when my boss says ‘you seem to spend a lot of your time gossiping’ I say ‘I’m not gossiping, I’m listening’ – and I pick up a lot more issues that way.

This quote illustrates the power of gossip to improve healthcare by acting as an early warning system.

Defining gossip

Gossip is informal, private communication between two or more people concerning the conduct of (usually) absent persons or events. It generally contains some element of evaluative talk or interpretation of the event, which may be verbal or written, implicit or unstated. Scandal occurs when gossip is elevated into the public arena, when “everyone knows what everyone knows”.4   

Gossip is a form of “common knowledge”, and it is everywhere. There is an evolutionary psychology view that language evolved to enable people to gossip5 in order to pass on socially relevant information necessary for survival. Such as who can / cannot be trusted, who will help you and who will stab you in the back, which are all still highly relevant in the 21st century workplace. 

Gossip in the workplace: myths and misconceptions

My research findings challenged three popular myths and misconceptions:

  1. Women gossip; men talk – there were no gender differences, but women were more comfortable using the term. For example, when returning from holiday women ask: “What’s the gossip?”; men ask: “What’s been going on?”
  2. Gossip is always negative – the nature of gossip as “evaluative” talk involves judgements about the quality, importance, amount or value of something.  This can also be positive, an appreciative comment about a colleague for example.
  3. Gossip is always wrong – there is always an ethical dimension to gossip. It can be harmful and wrong behaviour; or the information contained in gossip could be inaccurate or factually wrong. But it is equally wrong and harmful to ignore the “common knowledge” expressed in gossip, which could be an early warning of future failures and scandals.

A typology of gossip: the good, the bad and the toxic3

  • Good gossip – gossip as an inherently democratic process and resource for moral understanding and freedom of speech. 
  • Bad gossip – gossip as a breach of confidence and trust, or that is knowingly false or malicious.
  • Toxic gossip – is bad gossip taken to extremes, characterized by collusive dysfunctional processes which are detrimental to healthy social and organizational relationships.

The typology provides a way of thinking about gossip differently. It challenges the myths, misconceptions and negative stereotypes of gossip in order to see and hear “good gossip”. It also acknowledges that “toxic gossip” is a form of bullying, harassment and incivility,6 which also should not be ignored.

Rethinking gossip as organizational communication and knowledge

One of the outcomes of my research was a framework for rethinking gossip as organizational communication and knowledge, which includes core concepts of ethics, emotion, sensemaking, identity and power.     

A framework for rethinking gossip as organizational communication and knowledge 

These concepts can be used to reflect upon and “interrogate” incidents of gossip, or with which to answer the question: “What’s Trending on the Gossip Grapevine?” (rather like “What’s trending on Twitter?”). This provides a mechanism with which to:

  • Rethink the evidence-base for healthcare practice; and
  • Highlight the importance of the ethical issues of not attending to warning signs expressed through gossip.

When healthcare leaders ignore the warning signals expressed as – and through – gossip, this is “wilful blindness”. In other words, we choose to remain unseeing and not listening in situations where we could know and should know because we feel better not knowing.7 This sometimes occurs consciously but mostly not, and it is dangerous. The potential for harm by not attending warning signs in gossip, coupled with the potential for harm caused by toxic gossip, has led me to conclude:

The decision to gossip ‒ or not ‒ is always an ethical decision.

Kathryn Waddington

Rethinking the practice of evidence-based management in healthcare

In addition to ethical decision making, evidence-based management8 draws upon the principles of evidence-based medicine in order to help people in organizations make better decisions, based around four sources of evidence.

Evidence-based Management8  

Rethinking the practice evidence-based management in healthcare practice
Adapted from the Center for Evidence-based Management (CEBMa)8

Government-led inquiries2,3 have shown that organizational data and metrics can often override the values and concerns of stakeholders, and practitioners’ professional expertise. Gossip in business and organizational studies is now emerging as a new and rapidly evolving area of research,9 with the potential to significantly influence evidence-based management in healthcare in two areas of practice-based evidence and knowledge: (i) stakeholders’ values and concerns; and (ii) practitioners’ professional expertise, as shown in the feedback below from healthcare leaders.

Feedback from healthcare leaders

Note: in order to preserve confidentiality some of the material and examples used here are typical of the situations that challenge us in our working lives—and that are gossiped about—rather than real cases / scenarios. 

Shade Alu, Consultant Paediatrician: The term gossip has negative connotations, but it can be re-framed as “useful data”. The art of using gossip as useful data will be in receiving it with an open mind; if recurring and from several sources, be curious and interrogate the information being shared. It may be useful in giving early indications of what is good in the system but also what is not going well that needs addressing before it becomes a serious / significant incident.

Annie Topping, Professor of Nursing: Attending to gossip is about being alert and looking out for what doesn’t show up in the metrics. The hidden pockets of informal knowledge about what is “really going on” behind the bedside screens and behind closed doors. In my experience nursing and medical students are really good sense checkers – “out of the mouths of babes …” comes the (implied) truth or wisdom, which resonates with rethinking gossip as organizational knowledge. The ethical component of gossip is also relevant. I tend to ask, “why are you telling me this?” when gossip comes my way because it’s important to ascertain motivation; e.g. is it to avert harm, or cause damage to reputations? In COVID-19 times we now need to seek out new opportunities to listen, e.g. “loitering post zoom meetings”. 

Dean Fathers, Former NHS Trust Chair:  Having sat in and listened to numerous Board conversations in a variety of C-suite roles, I have learned the importance of narrative and to listen hard to what is really being said around the table or down the corridor of power. This article is an excellent resource for those who occupy or plan to take up seats at boardroom tables. It provides useful insights into the challenges of boardroom politics, and offers you tools to help you make better informed decisions around patient safety. I wish I had read it 30 years ago before I took on my first board role.

Actionable steps to incorporate gossip-based evidence to improve healthcare practice

The above feedback offers readers some real world examples of the benefits of gossip, which translate into the following actionable steps:

1Keep an open mind and create conditions for informal conversations, face-to-face and online
2Know your “gossip dealer” – can you trust them?
3Listen and verify – triangulation of gossip with other sources and data
4Start / end meetings by asking “what’s grumbling on the grapevine and do we need to do anything about it?”
5Set up a reverse mentorship scheme where senior leaders are mentored by “frontline” staff – Dean Fathers has reflected further on his experience of being mentored in this way:
Regardless of seniority we all need to learn, and it is important for senior people to seek out the sources of that learning from within the intelligence banks of the people within their organization
6Use the National Guardian Freedom to Speak Up Self-reflection template below to interrogate gossip in your organization and teams

National Guardian Freedom to Speak Up Self-reflection template10

The art and science of gossip: Rethinking evidence-based management in healthcare. National Guardian Freedom to Speak Up Self-reflection template
Adapted from the National Guardian Freedom to Speak Up10

Concluding prompts on the art and science of gossip and evidence-based management in healthcare

  • “Our globe discovers its hidden virtues, not only in heroes and archangels, but in gossips and nurses”—Ralph Waldo Emerson 
  • “Thus, the task is not so much to see what no one has yet seen; but to think what nobody has yet thought, about that which everybody sees”—Erwin Schrödinger
  • “Pay attention to the whispers so we won’t have to listen to the screams”—Cherokee proverb

Kathryn Waddington, PhD is a Chartered Psychologist and researcher in work and organizational psychology at the University of Westminster. She began her professional career in nursing before moving into academia, where her research interests include organizational communication and the development of compassionate organizational cultures and practices. She cares deeply about research that brings academics and practitioners together, and that makes a positive difference to people’s lives. She has recently edited and written the books Towards the Compassionate University: From Golden Thread to Global Impact and Gossip, Organization and Work: A Research Overview, which will both be published by Routledge in 2021. This expert opinion article is based on her doctoral research at the University of London into the role and function of gossip in nursing and healthcare organizations. More articles by Kathryn Waddington

References

  1. The Kerr/Haslam Inquiry (2005). Report available from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/273245/6640.pdf [Accessed July 2020]
  2. Saunders, J. (2013). Doctors and others: Reflections on the first Francis Report. Clinical Medicine. Article available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4952626/pdf/132.pdf [Accessed October 2020]
  3. Waddington, K. (2012). Gossip and Organizations. New York / Abingdon: Routledge
  4. Waddington, K. (2016). Rethinking gossip and scandal in healthcare organizations. J. Health Org. & Mgmt. 3 (6), 810-817. Article available from https://westminsterresearch.westminster.ac.uk/download/08b04d96559a9b8e8eb37db893141bf08e9315acc26cd646baac9a56ab9fdf62/281778/Waddington_JHOM_proof.pdf [Accessed July 2020]
  5. Dunbar, R. (1996). Grooming, Gossip and the Evolution of Language. London: Faber.
  6. Belak, T. & Waddington, K. (2021, forthcoming). What constitutes a compassionate university? Ch. 12 in Waddington, K. (Ed.) Towards the Compassionate University: From Golden Thread to Global Impact. New York / Abingdon: Routledge.
  7. Heffernan, M. (2011). Wilful Blindness: Why we Ignore the Obvious at our Peril. London: Simon & Schuster
  8. Center for Evidence-based Management. See:  https://cebma.org [Accessed July 2020]
  9. Waddington, K. (forthcoming, 2021). Gossip, Organisation and Work: A Research Overview. In Routledge State of the Art in Business Research Series. See: https://www.routledge.com/State-of-the-Art-in-Business-Research/book-series/START [Accessed July 2020]
  10. The National Guardian Freedom to Speak Up Self-Reflective Template. Template available from https://www.nationalguardian.org.uk/wp-content/uploads/2019/10/20190402-freedom-to-speak-up-self-reflective-template.pdf [Accessed July 2020]