Structures and practices of whistleblowing in healthcare: An integrative review

Abstract

<p>Wrongdoings occur in healthcare, and effective whistleblowing structures and practices are essential for ethically addressing these issues in organisations. However, research on whistleblowing in healthcare from an organisational perspective remains limited. The aim of this integrative literature review was to synthesise the empirical evidence about the structures and practices of whistleblowing in healthcare organisations. Whittemore and Knafl's methodology was followed, and the study selection process was documented using the Preferred Reporting Items for Systematic Reviews and Meta-analyses flow diagram. A systematic literature search was performed in February 2024 and updated in January 2026 across Cumulative Index to Nursing and Allied Health Literature, MEDLINE (PubMed), Scopus, SocINDEX, and Web of Science Core Collection. This search was complemented by a manual search. Peer-reviewed empirical studies published in English were selected. Data were analysed using inductive content analysis. Fourteen included studies were published between 2007 and 2023. Most studies were qualitative and conducted in the United Kingdom; the overall methodological quality was high. Five categories describing the structures and practices of whistleblowing in healthcare organisations were identified: (1) inconsistent, inadequate and insufficient structures and practices of whistleblowing, (2) the absence of standardised practices or their implementation in an inconsistent manner, (3) the influence of organisational culture and leadership on whistleblowing structures and practices, (4) the need for substantial development in whistleblowing structures and practices, and (5) the need to reframe attitudes towards whistleblowing as both an opportunity and a tool for organisational improvement. The results show the fragmented and inconsistent nature of structures and practices of whistleblowing in healthcare organisations; they also underscore the influence of organisational culture, leadership, and power dynamics on their effectiveness. The findings illuminate how internal whistleblowing develops and highlight the need for future studies that employ designs capable of more robustly evaluating whistleblowing mechanisms.<br></p>