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.
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).
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.
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.
From the *James Cook University Singapore; †Biomedical Institute for Global Health Research and Technology, National University of Singapore; and ‡Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Correspondence: Melvyn W. B. Zhang, MBBS, MRCPsych, Biomedical Institute for Global Health Research and Technology, National University of Singapore, MD6, 14 Medical Drive, #14-01, Singapore 117599 (e-mail: Melvyn_wb_zhang@imh.com.sg).
The authors disclose no conflict of interest.