A2 Refereed review article in a scientific journal

Structures and practices of whistleblowing in healthcare: An integrative review;




AuthorsJärvinen, Outi; Suhonen, Riitta; Wiisak, Johanna

PublisherSAGE Publications

Publication year2026

Journal: Nursing Ethics

Article number09697330261449295

ISSN0969-7330

eISSN1477-0989

DOIhttps://doi.org/10.1177/09697330261449295

Publication's open availability at the time of reportingOpen Access

Publication channel's open availability Partially Open Access publication channel

Web address https://doi.org/10.1177/09697330261449295

Self-archived copy’s web addresshttps://research.utu.fi/converis/portal/detail/Publication/526610327

Self-archived copy's licenceCC BY

Self-archived copy's versionPublisher`s PDF


Abstract

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.



Keywords:
integrative literature revieworganisationstructures and practices of whistleblowingwrongdoing

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Funding information in the publication
JW's contribution to this publication has emanated from research jointly funded by Taighde Eireann - Research Ireland under Grant Number 13/RC/2094_2, and co-funded by the European Union under the Systems, Methods, Context (SyMeCo) programme Grant Agreement Number 101081459. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Research Executive Agency. Neither the European Union nor the granting authority can be held responsible for them. Language editing was funded by Konung Gustaf V:s och Drottning Victorias Stiftelse. The authors OJ and RS received no personal financial support.


Last updated on 23/06/2026 03:11:05 PM