The Consequences of Whistle-blowing: An Integrative Review

Abstract

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.

Blowing the whistle: Perceptions of surgical staff and medical students in a public South African hospital

“…Current literature on whistleblowing in healthcare settings highlights the potential shortcomings of reporting systems that hinder the progress of reporting wrongdoing. Consequences of whistleblowing-such as character abuse, legal and financial penalties, and adverse impact on job security-highlight how crucial it is to protect whistle blowers (14). Our research supports this evidence; in freetext responses, 54% of participants said interpersonal factors (for example, relationships and hierarchy) hindered them from reporting events, and 14% said this was due to dangers involved.…”

“…This study sought to add to a limited evidence base within this area of professional ethics. Although there was one physician and the main cohort in this study was surgical staff, nevertheless, advances in whistleblowing can be extrapolated to other healthcare professionals and other medical specialties because of similarities in clinical environment and consequences of whistleblowing (14).…”

La dénonciation infirmière en contexte de pandémie de COVID-19: une analyse de contenu de la plate-forme « Je dénonce »

“…Pour le dénonciateur, des signalements internes peuvent entraîner une surveillance accrue de son travail par ses supérieurs, des évaluations de performance arbitraires, et de la distanciation de ses pairs. [17,18] En cas d'escalade des stratégies de signalement, le dénonciateur peut voir son jugement et sa compétence discrédités, une intensifi cation de la surveillance de sa performance, de l'ostracisme, du harcèlement, des menaces, et des représailles pouvant aller jusqu'à la perte d'emploi. Tous les écrits recensés rapportent des conséquences émotionnelles graves: isolement; perte d'estime de soi; désengagement envers les patients; désir de quitter la profession; anxiété, dépression; et, dans des cas plus extrêmes, le suicide.…”

“…Tous les écrits recensés rapportent des conséquences émotionnelles graves: isolement; perte d'estime de soi; désengagement envers les patients; désir de quitter la profession; anxiété, dépression; et, dans des cas plus extrêmes, le suicide. [17,18] Pour l'organisation, la dénonciation est généralement perçue négativement même si les problèmes dénoncés sont reconnus (19). Bien que des réponses constructives n'affl igeant pas le dénonciateur soient possibles, elles demeurent étonnamment rares.…”

Privatizing Plaintiffs: How Medicaid, the False Claims Act, and Decentralized Fraud Detection Affect Public Fraud Enforcement Efforts

“…Assembling a compelling qui tam case carries a large opportunity cost in terms of time. Bringing a suit against one's employer also carries the cost of potential reduced marketability for future jobs in the industry (Lim et al, 2017). The federal FCA provides remedies for employees who are fired, demoted, or harassed after filing a qui tam lawsuit.…”