Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews

Mannion, Russell; Blenkinsopp, John; Powell, Martin; McHale, Jean; Millar, Ross; Snowden, Nicholas; Davies, Huw

Abstract

Background
There is compelling evidence to suggest that some (or even many) NHS staff feel unable to speak up, and that even when they do, their organisation may respond inappropriately.

Methods
The study comprised four distinct but interlocking strands: (1) a series of narrative literature reviews, (2) an analysis of the legal issues related to whistleblowing, (3) a review of formal Inquiries related to previous failings of NHS care and (4) interviews with key informants.

Results
Policy prescriptions often conceive the issue of raising concerns as a simple choice between deciding to ‘blow the whistle’ and remaining silent. Yet research suggests that health-care professionals may raise concerns internally within the organisation in more informal ways before utilising whistleblowing processes. Potential areas for development here include the oversight of whistleblowing from an independent agency; early-stage protection for whistleblowers; an examination of the role of incentives in encouraging whistleblowing; and improvements to criminal law to protect whistleblowers. Perhaps surprisingly, there is little discussion of, or recommendations concerning, whistleblowing across the previous NHS Inquiry reports.

Limitations
Although every effort was made to capture all relevant papers and documents in the various reviews using comprehensive search strategies, some may have been missed as indexing in this area is challenging. We interviewed only a small number of people in the key informant interviews, and our findings may have been different if we had included a larger sample or informants with different roles and responsibilities.

Conclusions
Current policy prescriptions that seek to develop better whistleblowing policies and nurture open reporting cultures are in need of more evidence. Although we set out a wide range of issues, it is beyond our remit to convert these concerns into specific recommendations: that is a process that needs to be led from elsewhere, and in partnership with the service. There is also still much to learn regarding this important area of health policy, and we have highlighted a number of important gaps in knowledge that are in need of more sustained research.

Future work
A key area for future research is to explore whistleblowing as an unfolding, situated and interactional process and not just a one-off act by an identifiable whistleblower. In particular, we need more evidence and insights into the tendency for senior managers not to hear, accept or act on concerns about care raised by employee

Citation

Mannion, R., Blenkinsopp, J., Powell, M., McHale, J., Millar, R., Snowden, N., & Davies, H. (2018). Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews. Health Services and Delivery Research, 6(30), 1-190. https://doi.org/10.3310/hsdr06300

• Journal Article Type: Article
• Acceptance Date: Mar 1, 2018
• Publication Date: 2018-08
• Deposit Date: Jul 25, 2019
• Publicly Available Date: Jul 26, 2019
• Journal: Health Services and Delivery Research
• Print ISSN: 2050-4349
• Publisher: NIHR Journals Library
• Peer Reviewed: Peer Reviewed
• Volume: 6
• Issue: 30
• Pages: 1-190
• DOI: https://doi.org/10.3310/hsdr06300
• Keywords: Whistle blowing; Health care
• Public URL: https://hull-repository.worktribe.com/output/2239134
• Publisher URL: https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr06300#/abstract
• Additional Information: © Queen’s Printer and Controller of HMSO 2018. This work was produced by Mannion et al. under the terms of a commissioning; contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of; private research and study and extracts (or indeed, the full report) may be included in professional journals provided that; suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for; commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation,; Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
• Contract Date: Jul 26, 2019