Health professionals' experiences of whistleblowing in maternal and newborn healthcare settings: A scoping review and thematic analysis

PROBLEM

Whistleblowing, which involves raising concerns about wrongdoing, carries risks yet can be crucial to ensuring the safety of health service users in maternal and newborn healthcare settings. Understanding of the experiences of health care professionals that enact whistleblowing in this context is currently limited.

BACKGROUND

Notable inquiries involving maternity services such as those reported upon by Ockenden and Kirkup and the Lucy Letby case in the United Kingdom have shone an international spotlight on whistleblowing failures.

AIM

To identify and synthesise available literature addressing the experiences of healthcare professionals enacting whistleblowing in maternal and newborn care settings.

METHODS

This scoping review followed Arksey and O'Malley's framework. Five academic databases were systematically searched for documents published between January 2013 and October 2023 with additional searches of Google Scholar and related reference lists.

FINDINGS

Whilst 35 papers from international sources were identified, the majority originated from the United Kingdom, where recent high-profile incidents have occurred. Thematic analysis identified three main themes: 'Structural Power', 'Perfectionism' and 'Bravery, Hope and Disappointment', each with sub-themes.

DISCUSSION

Whistleblowing is frequently an altruistic act in a hierarchical system. It exposes poor practices and disrupts power dynamics, especially in challenging workplace cultures. Open disclosure, however, requires psychological safety. Obstacles persist, emphasising the need for a culture of trust and transparency led by individuals who embody the desired values.

CONCLUSION

Primary research on whistleblowing in maternal and newborn healthcare settings is limited. This study sheds light on power dynamics and factors that affect whistleblowing.

Radiology residency oversight: A Qui Tam wake-up call

Like every physician practice, academic radiology practices must pay heed to all governmental regulations. The federal False Claims Act serves to protect US taxpayers and requires strict adherence. Violations, often brought forth by whistleblowers, can carry steep financial repercussions.

How can the collaborative participation of regulators, whistleblowers, and parties effectively promote rumor management in public health emergencies?

To effectively address the mental health risks associated with public health emergencies, it is crucial to actively manage rumors. This study explores the dynamic evolutionary process of rumor diffusion and its collaborative governance in public health emergencies. A game-theoretic model is constructed, involving three main actors: regulators, parties involved in public health emergencies (PIPHE), and whistle-blowers. The behaviors and game outcomes of each party are analyzed, and the effectiveness and feasibility of the model are validated through numerical simulations. The findings of this study reveal that various factors, such as regulatory costs, penalty income, reputation damage for regulators; image loss, reputation enhancement, penalty expenditure for PIPHE; and time costs, social responsibility, and reward income for whistle-blowers, all influence the behavioral choices and game equilibrium of each party. Optimization strategies for rumor governance are proposed in this study, including enhancing the sense of responsibility and capability among regulators, increasing transparency and credibility among PIPHE, and encouraging and protecting the participation of whistle-blowers. This study provides a comprehensive analytical framework for rumor governance in public health emergencies, contributing to improving the governance of public health emergencies and maintaining online public health orders for social sustainability.

What are people's attitudes toward medical insurance fraud whistleblowers? a study from China

PURPOSE

Medical insurance fraud has caused huge losses to countries around the world, and public reporting has become an important means to combat medical insurance fraud. The attitude of medical insurance fraud whistleblowers affects people's reporting behavior, and understanding people's attitude toward medical insurance fraud whistleblowers provides a basis for further improving the system and policy of public participation in medical insurance fund supervision.

METHODS

We adopted the questionnaire method to conduct a national cross-sectional survey of the Chinese public and analyzed the data using Chi-square tests, Fisher's exact tests, and binary logistic regression models.

RESULTS

A total of 837 respondents were included, and 81.8% of the population had a supportive attitude toward medical insurance fraud whistleblowers, with gender, whether they had used medical insurance reimbursement, and present life satisfaction being statistically significant (P < 0.05).

CONCLUSION

The public is generally supportive of medical insurance fraud whistleblowers, and women, those who have used medical insurance for reimbursement, and those who are satisfied with their lives are more likely to be supportive of medical insurance fraud whistleblowers.

Brain games?

Whistleblowers and former lab members suggest a star neuroscientist routinely manipulated data, compromising a planned NIH stroke trial and key Alzheimer's research.

New Insurance Product Needed for Physicians: Coverage for Sham Peer Review and Hospital Immunity

This commentary article highlights the need for an insurance product for hospital-employed physicians that provides coverage against sham peer review and a complete defense against wrongful hospital allegations of incompetent, whistleblowing, or disruptive behavior.

The principle of double effect and external whistleblowing in nursing

Nurses are generally expected to raise concerns when a harm or wrongdoing is committed against patients. Should their concerns not be adequately addressed, then nurses may take the decision to engage in external whistleblowing. Given that it could have a negative effect on the health care organization or service, nurses may question whether they should engage in external whistleblowing. Consequently, is there an ethical criterion to discern whether the negative effect on the health care organization or service is ethically permissible? This paper argues for the suitability of the Principle of Double Effect as an ethical criterion. The position of this paper is that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e. the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect.

Star marine ecologist guilty of misconduct, university says

University of Delaware finding vindicates whistleblowers.

Whistleblowing without names is hearsay

Peter Gøtzsche's proposal to provide anonymity to certain people reporting bad practices within the pharmaceutical industry, regulatory apparatus or health systems is superficially appealing but likely to generate more problems in the longer run than it might solve in the short term. We need to analyse what features of our systems generate problems and correct those, rather than rely on insiders to report on the resulting problems, as all these reports do is offer a false sense of security that things are safer now that one problem has been identified.

The Consequences of Whistle-blowing: An Integrative Review

BACKGROUND

Whistle-blowing provides an avenue for healthcare workers to express their concerns when there is a breach of patients' safety. Most healthcare organizations have policies in place to prevent reprisals on whistle-blowers. Despite these protective measures, whistle-blowing often leads to negative consequences.

METHODS

A search of articles on whistle-blowing was conducted on MEDLINE (PubMed). Articles were included if they described the consequences of whistle-blowing in the following 3 areas: medical, nursing, and research/pharmaceutical research (Fig. 1).

RESULTS

The initial search criteria retrieved 1168 articles, 670 of which were identified for full-text review. A total of 82 studies were included in the final set of literature. Negative consequences to whistle-blowers include occupational, legal, financial, socioemotional, and other (e.g., physical health, character assassination) effects. Positive consequences to clinical services include improvements to patient safety and in successes of employment tribunal claims, settlements, and court injunctions. Positive consequences in research include retraction of articles (with fraudulent data) and changes to medical journal publication rules. Consequences of no whistle-blowing include investigations of individuals for not reporting and negative emotions such as guilt.

CONCLUSIONS

Whistle-blowing is an avenue to improving patient safety in healthcare. The findings from this integrated review will help shape new whistle-blowing policies. Future whistle-blowing policies must minimize negative consequences to whistle-blowers while enhancing levels of patient safety and quality of care rendered.

Whistleblowing Against Doping Misconduct in Sport: A Reasoned Action Perspective With a Focus on Affective and Normative Processes

Whistleblowing against doping misconduct represents an effective deterrent of doping use in elite competitive sport. The present study assessed the effects of social cognitive variables on competitive athletes' intentions to report doping misconduct. A second objective was to assess whether the effects of social norms on whistleblowing intentions were mediated by actor prototype evaluations and group identification and orientation. In total, 1,163 competitive athletes from Greece, Russia, and the United Kingdom completed a questionnaire on demographics, past behavior, social cognitive variables, and intentions toward whistleblowing. Regression analyses showed that whistleblowing intentions were associated with different social cognitive variables in each country. Multiple mediation modeling showed that attitudes and subjective norms were associated with whistleblowing intentions indirectly, via the effects of anticipated negative affect and group identification and orientation, respectively. The findings of this study are novel and have important implications about the social, cognitive, and normative processes underlying decision making toward reporting doping misconduct.

Recognizing the importance of whistleblowers in healthcare

ABSTRACT

Healthcare professionals who raise concerns about workplace safety or other problems should be praised as heroes and changemakers. However, some whistleblowers face retaliation for speaking out, and the incidence of retaliation cases against these employees has spiked during the COVID-19 pandemic. This article reflects on the role of whistleblowers and their importance to public accountability.

Early warnings of COVID-19 outbreaks across Europe from social media

We analyze data from Twitter to uncover early-warning signals of COVID-19 outbreaks in Europe in the winter season 2019-2020, before the first public announcements of local sources of infection were made. We show evidence that unexpected levels of concerns about cases of pneumonia were raised across a number of European countries. Whistleblowing came primarily from the geographical regions that eventually turned out to be the key breeding grounds for infections. These findings point to the urgency of setting up an integrated digital surveillance system in which social media can help geo-localize chains of contagion that would otherwise proliferate almost completely undetected.

Sexual harassment in academe is underreported, especially by students in the life and physical sciences

What factors predict the underreporting of sexual harassment in academe? We used logistic regression and sentiment analysis to examine 2,343 reports of sexual harassment involving members of university communities. Results indicate students were 1.6 times likely to not report their experiences when compared to faculty. Respondents in the life and physical sciences were 1.7 times more likely to not report their experiences when compared to respondents in other disciplines. Men represented 90% of the reported perpetrators of sexual harassment. Analysis of respondents’ written accounts show variation of overall sentiment based on discipline, student type, and the type of institution attended, particularly with regard to mental health. Our results suggest that institutional and departmental barriers driven by power asymmetries play a large role in the underreporting sexual harassment among students—especially those in STEM disciplines.

The Quest for Clarity in Research Integrity: A Conceptual Schema

Researchers often refer to "research integrity", "scientific integrity", "research misconduct", "scientific misconduct" and "research ethics". However, they may use some of these terms interchangeably despite conceptual distinctions. The aim of this paper is to clarify what is signified by several key terms related to research integrity, and to suggest clearer conceptual delineation between them. To accomplish this task, it provides a conceptual analysis based upon definitions and general usage of these phrases and categorization of integrity-breaching behaviours in literature and guidelines, including clarification of the different domains and agents involved. In the first part of the analysis, following some initial clarifications, I explore the distinction between internal and external rules of integrity. In the second part, I explore the distinction between integrity and lack of misconduct, before suggesting a recategorisation of different types of integrity breach. I conclude that greater clarity is needed in the debate on research integrity. Distinguishing between scientific and research integrity, reassessing the relative gravity of different misbehaviours in light of this distinction, and recognising all intentional breaches of integrity as misconduct may help to improve guidelines and education.

Encouraging and Rewarding the Whistleblower in Research Misconduct Cases

There are many pressures that militate against work colleagues "blowing the whistle" or "ringing the bell" on each other in respect of research misconduct. These pressures result in a significant proportion of such conduct not coming to light at all or coming to light later or less straightforwardly than is desirable. There need to be meaningful incentives for colleagues to draw to the attention of authorities concerns that they have about adherence by others to their obligations in relation to research integrity. The United States has a distinctive process under the False Claims Act which provides significant financial encouragement to such persons, known as "relators" under the qui tam scheme, including in the context of proven research misconduct. This editorial reviews prominent occasions on which qui tam actions have been taken and considers the ramifications of a US$112.5 million settlement arrived at in 2019 involving research misconduct at Duke University. It discusses the advantages and disadvantages of the incentives that lie at the heart of the United States False Claims Act and canvasses whether it should be emulated in other countries.

Correctable Myths About Research Misconduct in the Biomedical Sciences

A recent National Academy report on research integrity noted that policies are not evidence-based, with no formal entity responsible to attend to this deficit. Here we describe four areas of research misconduct (RM) regulations governing Public Health Service funded research that are empirically and/or ethically questionable. Policies for human subject protection, RM and conflict of interest are not harmonized, making it extremely difficult to deal with complex cases which often contain allegations in all of these areas. Second, detection of RM has depended entirely on whistleblowers in spite of evidence of significant under-reporting. Third, the scientific record is far from cleansed of the effects of falsified/fabricated work through current mechanisms of retraction. Finally, lack of fairness in the regulations may reflect lack of a Belmont Report-like document to guide ethics of RM policy. These issues are likely common in other countries. RM regulations should be harmonized with related regulations and their effectiveness tracked, open access to data for independent replication and improved statistical tests are an essential supplement to whistleblowers, correction of the scientific record will require a major effort, and further ethical analysis and guidance are as important as is empirical study for the improvement of RM regulations. Further consideration should be given to assigning current regulations for human subjects protection, RM and conflict of interest to a single authority and to the further development of a Belmont-like report of essential principles, for RM.

Exploring the utility of internal whistleblowing in healthcare via agent-based models

OBJECTIVE

The benefits of internal whistleblowing or speaking-up in the healthcare sector are significant. The a priori assumption that employee whistleblowing is always beneficial is, however, rarely examined. While recent research has begun to consider how the complex nature of healthcare institutions impact speaking-up rates, few have investigated the institutional processes and factors that facilitate or retard the benefits of speaking up. Here we consider how the efficacy of formal inquiries within organisations in response to employees' speaking up about their concerns affects the utility of internal whistleblowing.

DESIGN

Using computational models, we consider how best to improve patient care through internal whistleblowing when resource and practical limitations constrain healthcare operation. We analyse the ramifications of varying organisational responses to employee concerns, given organisational and practical limitations.

SETTING

Drawing on evidence from international research, we test the utility of whistleblowing policies in a variety of organisational settings. This includes institutions where whistleblowing inquiries are handled with varying rates of efficiency and accuracy.

RESULTS

We find organisational inefficiencies can negatively impact the benefits of speaking up about bad patient care. We find that, given resource limitations and review inefficiencies, it can actually improve patient care if whistleblowing rates are limited. However, we demonstrate that including softer mechanisms for internal adjustment of healthcare practice (eg, peer to peer conversation) alongside whistleblowing policy can overcome these organisational limitations.

CONCLUSION

Healthcare organisations internationally have a variable record of responding to employees who speak up about their workplace concerns. Where organisations get this wrong, the consequences can be serious for patient care and staff well-being. The results of this study, therefore, have implications for researchers, policy makers and healthcare organisations internationally. We conclude with a call for further research on a more holistic understanding of the interplay between organisational structure and the benefits of whistleblowing to patient care.

District nurses and NHS fraud

Two cases of fraud by district nurses demonstrate that district nurses need to be familiar with the behaviour that amounts to fraudulent activity, so they are able to protect NHS assets and take appropriate action to minimise the loss of funds needed for patient care and treatment. Fraud costs the NHS billions of pounds each year and takes money away from front-line services. The Fraud Act 2006 has made the offence clearer and easier to prosecute. Offences can range from false representation about qualifications and experience, to false timesheet claims and benefit fraud. In this article, Richard Griffith outlines what constitutes fraud and the measures taken by the NHS to counter fraudulent activity.