When care is needed: the role of whistleblowing in promoting best standards from an individual and organizational perspective

The aim of this paper is to scan the evidence and to make sense of the processes underpinning the maintenance of care standards and the meaning and significance of whistleblowing in the available literature. It formed part of a project examining attitudes to whistleblowing in the care of older people in Wales. The paper focusses on the actions of employees within organizations (such as hospitals or domiciliary care organizations) or professional groups (such as nurses and doctors) but does not include reference to whistleblowing or the raising of concerns by members of the public (such as relatives or patients).

–Published literature concerning whistleblowing in the UK and internationally was considered. Health and social care databases were searched (including PubMed, MEDLINE, CINAHL, BNI, PsychLit, ERIC) and a wide variety of opinion pieces, research and theoretical explorations were accessed. Additionally, because whistleblowing occurs in workplaces other than health and social care, databases in the humanities, law and business were also searched. Other useful documents included public inquiry reports on matters both of public concern occurring in health and social care (e.g. The Shipman Inquiry, The Bristol Inquiry) as well as inquiries into events outside of this sector where whistleblowing was significant.

–There is no widely accepted theoretical framework or universally accepted conceptual underpinning for whistleblowing in the literature. This paper reveals various associated meanings, but all sources agree that whistleblowing is an imposed, rather than a chosen, situation and that whistleblowers are usually ordinary people who become aware of negative situations forcing them into a decision to remain silent, or to speak out. Another area of agreement within the literature is that the term whistleblowing has attracted overwhelmingly negative connotations. The simple choice between taking action or remaining silent belies the complexity of workplace cultures; including the care of older people.

–The paper explores a range of published sources from health care as well as other sectors. Although whistleblowing has been recognized as making an important contribution to patient safety, and the saving of lives, it has also had a somewhat tortured history in the health and social care sector, as well as in other industries. This paper explores whistleblowing in the context of recent UK policy developments and suggests the need for workplace cultures to be better understood; as well as promotion of open communication regarding concerns or unsafe practices.