The Impact Of Whistle-Blowing On The NHS And Its Employees

Write a report which explores the impact of whistle-blowing on the NHS and its employees.

Your topic is The impact of Whistle Blowing in Organisation Learning In NHS.

Background

It is inevitable that healthcare workers during the long period of their career could witness and actual or the potential threats to patient safety. Hence, some of these threats could result in serious harms occurring to others, while sometimes such threats could result in a least harm. In spite of the fact that healthcare service providers are encouraging employees to share their concerns in terms of the threats, healthcare system in an internationally struggle to engage their employees to do the same. The governments and the regulatory bodies have made several acts for the protection of employee rights and the dismissal of many unscrupulous activities. Particularly, The Act formed in 1998 did not have any issue in blacklisting the whistle-blowers. It is identified that the employment Tribunal System (ET) is not a low-cost and informal solutions to resolve PIDA issues. However, there is a criticism that there is no administrative alternative to ET systems, which whistle blowers may approach the court if any difference occurs to them. 

An individual organizational member or the contractor who reveals about the illegal, unethical or any sort of wrong-doings in the organization that is performed by an individual or the group implement the practice of whistle blowing as the disclosure of information. It is certain that a whistle blower has the access to the source of information of the business, as that person is insider of the organizations and has proper understanding regarding the organization (Bourne et al. 2015). Many studies have been performed to identify and analyse the impact on whistle blowers in an organization but most of these studies are based in United State and other nations. Hardly any research has been performed considering the healthcare services in UK. Thus, the purpose of this is to discuss and evaluate the impact of whistle blowers of whistleblowing in organizational learning under NHS. National Health Service (NHS) is widely known for its top class services revolving around mental health issues and the organization delivers the unique needs of aged population as well as commitment towards the health issues (Park, Blenkinsopp and Park 2014).

As put forward by Liu, Liao and Wei  (2015), whistle blowing delivers a pathway for the healthcare workers to express or share their concern particularly when there is a breach of patients’ safety.  Nonetheless, Bourne et al. (2015) here commented that many healthcare organisations have policies in place to prevent reprisals on whistle blowers. In spite of such as protective measures, whistle blowing often lead to negative results. However, there is a state of doubt that whistle blowing could be a creditable endeavour, even though, there is a scarcity of coverage in the literature of cases that detail the manner in which the whistle blowers lead to enhanced patient safety (Nhs.uk 2018). Thus, there is an indirect evidence which supports the argument that a whistle-blowing culture could be creditable, which consists of retrospective analysis of several cases in which significant failing of safety can occur because of the whistle blowers remain in the back of the incident. Therefore, this sort of reflective analysis has made the attempts to normalize whistle-blowing as one of the significant approach of enhancing safety. Nonetheless, considerable work to be done to make sure and show that whistle-blowing informs safety prospectively instead of belatedly knowing learning from whistle-blowers once the damaged has already occurred to patients or the organizational members.

The Practice of Whistle-Blowing

There is a question that whether there is any solid proof for the existence of prospective system of organizational learning from employees’ concern? Such system particularly in UK is conventionally indefinable. Nonetheless, the work presently being performed with respect to the recent failures to learn from employee concerns’ indicate that change may be looming. According to Ashton (2015), due to the move towards the care, the increased competition amongst the healthcare organizations and the requirement to cut costs to remain competitive, an individual make assumptions that the condition, which give rise to typical instances of whistle blowing, could continue to deteriorate. In this context, Cho and Song (2015) commented that whittle blowing need not to occur as there could be internal procedure to resolve the issues. According to this author, whistle blowing remains as a moral action of last resort and under a particular circumstance, it is not only effective but essential. As put forward by Park, Blenkinsopp and Park (2014), whistle blowing is referred to action of warning, which is issued by a member or former member of an organization to public regarding serious unscrupulous activity within the business or the organization.

National Health Service launched in 1948 and it was found with the purpose of making healthcare available to all, irrespective of wealth (Nhs.uk 2018). The establishment of NHS helps to enhance the public health services UK. In addition, NHS in England deals with over 1 million patients in every 36 years. It may cover everything major mental health service, routine screenings, treatments for long-time conditions, transplant and old-life care. NHS presently had 1.5 million people and it holds the 5^th position in world’s top five largest workforce firm (Nhs.uk 2018). Particularly, in NHS, the total number of clinically qualified staff includes 150,273 doctors, 40,583 general practitioners (Nhs.uk 2018).  Although, NHS is known for its high and unique quality of healthcare services but in the recent time, the incident of Mid-Stafford have tarnished the image of the quality service of NHS and led the setting to make whistle blowing. NHS provides Whistle Blowers Support Scheme could offer a range of services with the inclusion of career coaching, financial advice as well as mediation for primary care staff who suffered due to increasing concerns about the practices followed in National Health Service. The setting also applied a working transaction to operate the pilot until March 2018. The scheme has been developed with the help of former staff, who experienced whistle blowing and the influence it can have on the employees. Nonetheless, Wainberg and Perreault (2015) mentioned that some individuals who have increased the concerns observe experience severe difficulties when asking for a re-employment in the health care service. This indicates that they are particularly excluded from the capability of working in their selected field. The present scenario clearly indicates that the organization requires to amend its whistle blowing policies.

Impact on NHS Employees

Investigation in United Kingdom into mistreatment of aged people by healthcare employees over to the last three decades have focussed on introducing or supporting employee whistle blowing. Even though whistle blowers have made a significant contribution to patient safety, it remains as a controversial agenda. Such fate of whistle blowers remains bleak, which could result in personal and professional sacrifices. Whistle blowers have been characterized in the existing studies as the courageous employees who usually act to maintain the standards “against the might of faceless organization”. In this context, Park, Blenkinsopp and Park (2014) commented that whistle blowers are also the malcontents, who could stop at nothing to follow their agenda irrespective of destructive and negative outcome of their actions for colleagues and organizations.

Nonetheless, whether the whistle blower is considered as the hero or the troublemaker, it remains as the anomalous natured of whistle-blowing that it creates special interest to those individual researching the care of vulnerable groups. Gao,  Greenberg and Wong-On-Wing (2015) argued that even though the development has been made in comprehending the nature of whistle-blowing but the question still remains which may or may not be due to the tendency by policy makers and scholars to oversimplify the ways that concern regarding the quality of care dealt in the workplace setting. Park,  Blenkinsopp and Park (2014) performed a research and found that a tendency in the papers to insist on dichotomous choice between the silence and the whistle blowing and so when they face the wrong doings, an organizational member can make the decision of either to remain silent or respond by blowing the whistle. In addition, it has been identified that those individuals who seek attention to possible wrongdoings within the firm are the subjects of much controversy. According to, Andon et al. (2016) whistle blowers are noble characters, who intend to sacrifice personally and professionally to expose organizational practices that remain wasteful and fraudulent to the public safety. While, Guerciet al. (2015) mentioned that whistle-blowers are mainly disgruntled employees who unkindly accuse individuals they feel have harmed to attain their own selfish goals. However, there is a series of arguments on whistle blowing on organizations. Therefore, it is yet unclear how or to what extent whistle blowing can affect the organization. Thus, it is highly necessary to conduct a research to learn the cause of whistle blowing and its impact on the employees. It also focuses on the manner in which organizational learning about whistle blowing is processed.

• To recognize the factors which leads to whistle blowing in NHS (as an organisation)
• To determine the rate of impact of whistle blowing on the employees
• To understand the impact on the management of the organisation
• To identify the advantages and disadvantage of the process
• To explore the response and learning of the organisations (NHS) towards whistle blowing and protecting the interests of the whistle-blowers
• To seek recommendations to protect the whistle-blower and make the organisation more accountable

Impact on Patient Safety

The aim of the research is to understand the degree of impact of whistle blowing in organisation learning.

The objective of the research:

• To recognize the factors which leads to whistle blowing
• To determine the rate of impact of whistle blowing on the employees
• To understand the impact on the management of the organisation
• To identify the advantages and disadvantage of the process

• R1 what are the factors which leads to whistle blowing?
• R2 what is the rate of impact of whistle blowing on the employees?
• R3 what is the impact on the management of the organisation?
• R4 what are the advantages and disadvantage of whistle blowing in organisation learning?

This is the introductory chapter of the project work, which mainly introduces the topic and background to the topic. On the basis of the background presented, research objectives and questions have been formed which further leads to a detailed review of existing papers on whistle blowing in the next chapter.

This paper provides a detailed review of the existing studies that have been conducted on whistle blowing. The purpose of this review is to derive an understanding about how the organizations are dealing with the practice of whistle-blowing as well as whistle blowers. The review helps to know that although, healthcare origination provides appropriate guidelines for blowing whistle to notify the wrong-doings in the organization, due to the mistreatment from the seniors, fear of being in the limelight, many employees remain silent despite the transparency in the policies. This review will help to know the manner in which  the whistle-making policies are formulated and implemented on the identified scenario. The review also helps to identify the gaps in the previous study, which is supposed to be fulfilled in the present study.

This chapter presents a set of research techniques, which have been used to perform the research. The application of research techniques determines the outcome of the research. The concept of research paradigm used in the study is a set of beliefs and agreements that is usually shared between the social scientist. The study includes the strategy of ethnographic and case study analysis (Skivenes and Trygstad 2017). Particularly, this ethnographic technique of the study is associated with social interaction and cultural groups that are figured out to be the groups as communities, societies and organizations. Ethnography technique has been used because it provides a deeper understanding of the design issue with the inclusion of pertinent domain like audience, processes, context and goals. The secondary data has been collected to engage with the relevant literature as well as investigate the organizational structure of NHS and the history of whistle blowing to conceptualize the study.

This chapter presents the data and the findings with charts and tables. The chapter also includes the analysis of the collected data. The analysis of qualitative data has done by linking the data with the findings of the literature review. Likewise, an interview analysis has been conducted in the chapter with different themes derived from the qualitative questions.

Whistle-Blowers Protection and Support

Conclusion and Recommendation

This is a final chapter of the dissertation, which concludes the entire research work with a proper implication. A set of recommendation has also been provided in the chapter to address the issues related to whistle blowing in NHS.

This chapter of the dissertation holds the backbone of the entire research project as it effectively introduces the topic along with a detailed background. Background of the study presents the facts that there are certain procedures and norms which should be followed before blowing the whistle. Wrongful activities in the workplace are subject to negative consequences; but the whistle blowers need to be cautious about the action as inadequate evidences can hamper the image of the organization as well as the individual. On the basis of the background provided, research aim and objectives have been formed which stand as pillar of review of existing papers.

This chapter discusses and provides the findings of the literature on the impact of whistle-blowers on whistle-blowing on organizational learning under National Health Service London. The purpose of the review is to derive an understanding from the viewpoints of the scholars on how whistle blowers influence the organization. In order to conduct the review of literature almost twenty five journal articles and books have been used. The impact of whistle blowing is a significant context which needs to be reviewed because a greater support is required to deal with emotional consequence of whistle blowing.

As put forward by Liu, Liao and Wei (2015), whistle blowing remains a general shorthand for a situation where an organizational member exposes information or any unscrupulous activity in the work-place that is considered illegal, unethical leading to harm. According to Bourne et al. (2015), the Mid Staffordshire Public inquiry disclosed that a catalogue of preventable concerns regarding how whistle blowing is usually managed. The study has particularly mentioned that there are different factors which could affect whistle blowing including the expectation of staff loyalty and the assumptions that the NHS provides the best health service in the world. On the other side, Posey, Roberts and Lowry (2015) mentioned that whistle blowing is never an easy option. People prefer to be accepted by those around them and conform to group norms and accept instructions from those in the authority and even when their actions could harm others. Skivenes and Trygstad (2017) performed a study and provided a Francis Report which helps to identify that staff have the fear about revealing and when they did speak about the internal procedure, the senior staff in the organisations were hostile towards them and strongly defended the sub-standards practices.

Organisational Learning and Whistle-Blowing

On the other hand, Ciasullo, Cosimato and Palumbo (2017) mentioned that whistle blowers of the past elucidates problems still faced presently within National Health Service. Here,Ashton (2015) argued that 1960s have observed a significant controversy around the long-stay institution. The authors have also mentioned that even though the 1960s did not seem to be the time of NHS austerity, the resources were unevenly allocated. A study performed by Gao,  Greenberg and Wong-On-Wing (2015), mentioned that psychiatric hospital from which most of the reports come from, remained consistently less and it was effectively funded than the general hospital and in under such setting, the long stay wards remained as the least well resourced. According to the authors, Hospital Plan (1962) focused on expanding general hospital as well as community care and the execution process remained slower for long. Furthermore, it has also been identified that Psychiatric hospitals tend to designate for closure and receive little attention, which adds to their Cinderella. Some of the barriers, they face provide understanding which is relevant to National Health Service today.

A study performed on whistle blowing performed by Mannion and Davies (2015), the role of whistleblowing remains very critical because it could stop wrong and unethical activities and address the issues. In the same context, Bashir et al. (2011), whistleblowing serves as a control mechanism to identify as well as prevent wrong doing activities in the workplace. Particularly, when the wrongful activities remain serious, it may impact the overall business of the organisations significantly and here whistleblowing could serve as a protection. As the consequence, the use of resource can be saved and performance can be enhanced, which eventually improves the effectiveness of the control system. The author of this study has also mentioned that on a frequent basis, organizations or the related parties may retaliate on the reporting. On the contrary, a study performed by Lachman (2008), mentioned that whistleblowing might also cause disharmony in the organization. According to this author, it might destroy the victim’s business’s public image. In most of the instances, the initial reporting such as tips could trigger further investigation on some reported cases. Taking the future implications in consideration of such actions, studies demonstrate that employees of the organization who tend to contemplate to report wrong activities are supposed to be anonymous, particularly the employees in smaller organizations. In addition, a study conducted by Posey, Roberts and Lowry (2015), reveals the fact that employees may blow the whistle outside the organisations when they have strong evidence for wrongdoings.  However, it is also stated as a necessity for the employees for reporting the wrongdoing activities internally before bringing the matter to public because this might be less harmful to the victim of the organizations and moreover, it is less risky to the whistle-blowers.

Controversies Surrounding Whistle-Blowing

According to Mannion and Davies (2015) some studies tend to argue on the nature of whistleblowing decision, particularly, whether it remains as a process or direct decision call made by individual employees. According to the author, before reporting to the concerned authority, respective individual whistle-blowers should make some assessment which could include weighing the decision from the perspective of cost and benefit. In this context, Bashir et al. (2011) mentioned that decision to blow the whistle could involve a range of process at least four key significant elements such as the act of whistleblowing, the whistle blowing recipient and the victim organization. In general, the technique to blow the whistle begins with the decision taken by the individual employees, whether a specific practice in the organization is considered unethical. By considering such action as the wrongdoing, the organizational members then could decide whether or not to create a report. However, such judgment may contain several perspectives. The above-mentioned study ascertains the fact that decision is mostly depending on the seriousness of wrongdoings as well as exposure to reporting effectiveness. Apart from this fact, the individual employees may consider reporting effectiveness.

Therefore, in this regard, the literature reveals the individuals are more likely to report when they believe that the disclosure could be able to prevent the wrong activities so that they have no other alternatives to do the same. Hence, Posey, Roberts and Lowry (2015) commented that reporting decision can also be influenced by some conditions and due to some personal characteristics of the potential whistle-blowers. Thereafter, on receiving the report, the victim organizations could make an appropriate responses. The studies highlight that the response remains significant as it reflects firm’s attitude towards whistleblowing and this might create an impact on employees’ evaluation on the range of their personal cost to report.  Greene and Latting (2004) performed a study and recommend thatthe quality of information about the illegal or wrong doings and the anticipated organizational response are significant throughout whistleblowing process. Significantly, the response to wrongdoing need to be carefully considered because it might be inappropriate, in spite of the attempt to be rational. Moreover, this response could differ significantly on the basis of whether the individual reporter is internal or outside the business.  Such statementseffectively supported because it was discovered that disclosure in the external environment remains more effective in changing organizationalpractice compared to the internal reporting.

It is found that due to the nature of complexity, there is no such single theory which could adequately describe the characteristics of the whistle blowing. However, the studies conducted earlier have incorporated models from several theory to describe the decisions talent for whistle blowing – such as the theory of pro-social behaviour, bystander intervention theory and expectancy theory. Notwithstanding, the relationship between the variables is somewhat inclusive.

Research Aim and Objectives

According to Birtch,  Chiang and Van Esch (2016), humans are or treated as the social creature and they could socialize as well as cooperate among each to remain active or to survive in general. In several cases, the humans could expect return on their actions towards the others. Thomas et al. (2014) on their human behaviour studies have described this as the situation as the process of social exchange, which could lead towards the development of social exchange theory. On the other side, Yan et al. (2016) mentioned that theory of social exchange is depended or based on the quality of mutual exchange among the related entities. Nonetheless, Liu et al. (2016) considers this theory as mostly debatable; thereby, more intensive studies are required to focus particularly on some issues like conceptual roots, norms and rules of exchange and the nature of exchange resources as well as the connection of social exchange. A significant hypothesis assumed by this particular theory is that the social exchange techniques might have a strong impact on the feeling of obligation between the parties involved. On the basis of this perspective, scholars are in the dilemma to further understand whether the norms and rules of exchange from the social setting could also be assimilated in a business context. So, a more significant concern is that can anyone develop the impact of social exchange theory, on the basis of an employee-organization perspectives on a whistleblowing decisions.

In spite of the fact that social exchange theory regards social communication among human beings, the core philosophy of social exchange theory is transferable or can be translated into organizational context, which further emerges with organizational exchange theory. In a general sense, the theory of organizational support could examine organization’s readiness to provide employees with rewards due to their increased efforts and socio-emotional requirements. In this context, Jackson et al. (2010) commented that such perspective remains crucial in understanding the relationship between the employees and organizational relationship, within and beyond the scope of employment contact. Thus, it could describe the exchange between loyalty and effort for the advantages and rewards. A study performed by Jones (2016) reflected that the organizational members tend to associate their organization, which remains as a partner of social exchange, with the characteristics of individuals. It is identified that such personification is highly required to validate interpersonal commitment between two significant entities. Such technique could cover a series of responsibilities such as legal, financial and moral of organizations’ agent that in general considers the policies, culture and norms in business. In addition, action of the agents of the organization is usually considered as organizational intent, rather than agents’ personal motive. It can be ascertained that such perspective is crucial because it could suggest that significant reciprocity may not occur when they employees considers that those treatments are provided willingly.

On the basis of the concept of the reciprocity, the scholars in organizational studies develop a significant term called perceived organizational support which could cover a two-phased process. Ko and Hur (2014) performed a study and found that individuals employees tend to make evaluation of organization’s treatment which they observe. Particularly, the authors of this study have highlighted the fact that organizational members could make assessment and develop a general belief of the extent to which active organizations tend values their contribution and take care of the growth and development. This study also indicate the fact that considering the extent of the reciprocal relationship, such perception of reinforces organizational members’ effort to achieve organizational goals.  On the other side, decades ago, Kurtessiset al. (2017) performed a study and found that perceived organizational support is based on the absenteeism and it was found that the respondents with increasing perceived organizational support could less likely be absent at work. This particularly study also highlight the fact that perceived organizational support relates to job satisfaction, particularly at it meets socio-emotional needs of organizational employees. Therefore, the authors suggest to build a significant relationship with organizational justice, support from the supervisors, healthy conditions as well as favourable organizational rewards. All such perspective tend to demonstrate that employees tend to show a significant commitment toward their current employer when they have a belief that they have two-way communicative relationship that could go beyond formal responsibilities towards each other. The study also asserts that such relationship could reflect the organizational citizenship behaviour.

On the basis of the findings, it can be mentioned that employees’ whistle blowing behaviour in organizational remains significant to improve the effectiveness and efficiency of internal operational system. It is worth mentioning that while the discussion on this decision were observed to be varied in different context, the existing studies do not differentiate the role of several perspectives which lead to the actions. Nonetheless, the attention can be biased and thereby the efforts to create a balance between these opinions are required.  Therefore, by resolving whistleblowing decisions on the basis of a theoretical perspectives, the author’s suggest that social exchange theory deliveries a significant understanding into the object. Moreover, in an organizational context, it is worth mentioning that organizational support theory often contributes to a comparable purpose.

Essentially, the theory of organizational support provides another significant concept that the relationship between employees and organizations should be reciprocal. Therefore, they could reciprocate the treatment that they get. Such judgment is known as a perceived organizational support. The finding of the studies present above indicate that fact that the effect of such reciprocal relationship could increase or strengthen the commitment ties which is between the two parties. So, here the employees may tend to show a strong commitment towards the organization when their perceived organizational support remains high. Such commitment is shown with the help of the actions that are carried out in the organization’s best interest. Lastly, in this context, it can be mentioned that whistle-blowing is claimed to satisfy this condition because the decision is meant to benefit the organization.

As put forward by Cho and Song (2015), when a government employee or the employee of a private organisations reveals an illegal news, unsafe or unethical conduct regarding their employer, that employee could blow the whistle on that employer or the organization for the behaviour. The action of blowing the whistle on corrupt firms could create a strong influence, including both positive and negative (Guerciet al. 2015). A study performed by Park, Blenkinsopp and Park (2014), have mentioned about some of the advantages and disadvantage of whistle blowing.

According to Caillier (201.), the whistle-blower usually serve as a vital function in government and business. This paper also provides another fact that when the government and corporation agencies tend to step over legal and ethical lines, whistle blowers could make the practices pubic knowledge, which could further lead to violators that are being held accountable. The investigation comes with the criminal investigation, civil law suit as well as media attention could influence the behaviour of similar firms. The agencies and government offices that involve in similar misconduct may have previously believed that they can get away with the negative behaviour; however, the ripple effect of the whistle-blower’s efforts could introduce some significant changes.

Whistle Blower Protection Program could protect employees who report violations of different workplace safety, financial reform, environmental and securities laws. Such program could protect from retaliation workers who could blow the whistle on their employer’s behaviour (Guerciet al. 2015). In this context, Andon et al. (2016) also mentioned that retaliatory action may include dismissal, demotion and denial of major benefits and the reduction of working hours. The organisations that are found to be in the violation of whistle-blower protection laws could face direct penalties, suspension of government contracts and civil laws.

As mentioned by Lavena (2016), the attention that a whistle-blower case usually brings to employees and the organization might have a shortcoming. The authors of this paper have also mentioned that media interviews, investigation from the government and legal testimony could affect the whistle-blowers’ career prospects. On the other side, Campbell and Göritz, (2014) mentioned that while the outside world could consider whistle-blower as hero for revealing the corrupted behaviour, the insiders in the industry and hiring managers might have observed them as a disloyal or discreet  for not keeping the organizational secrets and industrial practice under the wraps. Caillier and Sa (2017) commented that here the media attention could lead to whistle-blower, which is being blacklisted in the sector.

According to Wainberg and Perreault (2015), even though whistle blowers could understand that their revelations tend to serve the good and they often endure the personal issues from their own actions. It is also identified that media outlets for the sake of searching the story, which could get into whistle-blowers’ personal lives. On the contrary, Gaoet al.(2015) mentioned that legal complication from the criminal investigations as well as civil lawsuits against the agency might require them to hire attorneys to defend themselves. They could receive threats from the retaliation from the earlier supervisors or the colleagues. This could further go into personal issues and fracture in their relationship.

As put forward by Caillier (2015), for employees who involve in whistleblowing on an organization, the stress could become overwhelming. Many whistle blowers tend to remain at their place of employment after coming forward as it is illegal to fire someone for it. Nonetheless, these people could often experience some particular experience symptom including insomnia, anxiety and headache. In such context, Cho and Song (2015) mentioned that there could be some retaliatory act against whistle-blowers which could further cause heightened stress and discomfort in their jobs. It is also identified that close supervisors and alienation by co-workers could also be the causeof the stress. A study performed by Park, Blenkinsopp and Park (2014) have stressed on the termination when it comes to whistle-blowing. According to the author, some people have been terminated for whistle blowing even though it is illegal. For instance, if an individual is terminated, that individual will have to prove whistle blowing violation.

An employee needs to prove that he/she engaged in a safe and protected activity such as asking for overtime pay, report of sexual harassment or applying the medical leaves and maintaining a healthy work life balance. In the same context, Liu, Liao and Wei (2015) mentioned that a whistle blower does not have to exemplify an actual violation of the laws as long as employee has a reasonable and strong belief and that a violation of the law has taken place or may take place in the coming future. The author of this research paper has also mentioned that whistle blower always takes the burden of developing that he/she was justified in believing that a report is highly necessary. Hence, Bourne et al. (2015) argued that it is not protected whistleblowing when the employee has no proof of a violation of the laws and employee’s suspensions were not reasonable at the time when he/she made a threat to the report. Conversely, Caillier (2015) mentioned about some positive effects that could result from whistleblowing. According to the author, it can change policies that benefit employees and other individuals. It can be well understood with the example, in 1996 Jeffrey Wigand, a tobacco researcher blew their whistle on the brown &Williamson Tobacco Corporation with the claim that the agency knew tobacco was addictive (Bourne et al. 2015). The outcome come out a change in public policy and change in public perceptions of tobacco sector and this further have a strong impact on the society as a whole.

Antecedents of whistleblowing

A study performed by Greene and Latting (2004), revealed the findings that many negative terms including “company traitors”, “informers, rats and moles’ and ‘internal muckrakers’ have been applied to define workers that have reported illegal or wrongdoing at work. Yet, there remains a little empirical support for the relationship between personality as well as whistleblowing. Another study by Mannion and Davies (2015), mentioned that no personality measures (including compliance with supervisors, submissiveness to organizational authority as well as self-righteousness) were related to whistleblowing intent. On the other side, Bashir et al. (2011) performed a study and identified some support for a link between proactive personality as well as whistle-blowing. The author has also made an assumption that some range of moral reasoning could influence whether or not an employee reports to unscrupulous activities.

Nonetheless, as per the previously mentioned review of whistle blowing article by Walshe and Shortell (2004), none of the involved studies have discovered a constant relationship between measures of moral and whistle blowing. Likewise, a latter meta-research performed by Lachman (2008), is also failed to find a consistent relationship between ethical judgement and whistleblowing in the involved studies of investigation. Therefore, in spite of the limited amount of studies performed on the relationship between moral reasoning and actual whistleblowing, finding of empirical studies suggest that relation between moral reasoning and the act of whistleblowing is never as clear as it appears when considered from theoretical perspectives. According to the power theory mentioned by Akabayashi (2002), an employee’s social and professional power is estimated to create impact on whether an employee decides to repot wrongdoing or not. The finding of another study carried out by Jackson et al. (2010), supported this assumption to some extent by demonstrating that whistle-blowers predominantly seemed to be male professional with high wages.  This assumption only receives a partial support but Bowen, Call and Rajgopal (2010) particularly mentioned that whistleblowing is predominantly associated with individual characteristic such as organizational tenure, gender and job level but the author has clarified that job positioning is particularly associated with reporting unscrupulous activity at work. So, it is can be mentionedthat most consistent personal characteristics related to actual whistle-blowing appear to be job position.

As put forward by Murray (2007), whistleblowing can be defined as the action of disclosure by the organizational members of illegal as well as illegitimate practice under the control of their business owners who could be able to influence the action. Even though, it seems to be harmful to the organizational interest; however, whistle blowing could be managed to develop organizations. Thus, it can be mentioned that whistle-blowing could play a great role in improving accountability, transparency and effective governance to develop the organization as whole as it is broadly accredited as one of the most significant method as the part of internal control system in the business to detect and stop corruptions and illegal activities.

As put forward by Summers and Nowick (2003), it is the right of the managers to share instead of asking and listening and perceiving whistle blowers as malcontent “wimps” who observe safety hazards everywhere. Here, Hannigan (2006) arguably mentioned that when the managers are supposed to listen as the causes has blown up into a proper scandal and they can consider it as exception and attempt to recognize few rotten apples in the barrel who are doing and spreading the practice of wrong activity. Thus, there is an appetite leadership to question their own position, to make themselves vulnerable by acknowledging that sub-ordinates could know things and could observe systematic things that are could be critical to development of the overall functioning of the business or the organizations. According to Gundlach, Douglas, and Martinko (2003), the leaders prefer root cause analysis and thereby to locate people to blame instead of examining the systemic forces at work that could cause bad things to happen in a timely manner.  To resolve this issue, the authors as the suggestion have mentioned that to address such as problems, it requires a range of “adaptive move”.

One of these may take a different approach to the investigation of scandals and accidents like patient deaths. So, rather than paying attention to root causes as well as people to blame, one should assume that people act in good faith on thebasis of their evaluation of the situation at the moment. Hence, Cruise (2002) argued that it is worth accepting what safety experts have demonstrated on a regular basis- actions and ultimate outcome are over-determined that what people do and what eventually happens usually have multiple reasons. Furthermore, Park and Blenkinsopp (2009) performed a study and found that work particularly in real situations such as in the hospitals could always experience some amount of “practical drifting”, which means a deviation from the desired behaviour or what the rules. There is a need due to the regional circumstances that make it highly essential for people use their own judgments and sometimes choose to break the rule to perform the job effectively. The major adaptive move here is to redesign the glasses rather than punishing the workers for breaking the rule.

There could be several factors leading to whistleblowing and the issues can be encountered in any environment where people live together. As put forward by Pittroff (2014), whistle blowers claim that healthcare industry is a common place under which a number of different laws and circumstances are there. As per the investigation of Federal Bureau of Investigation, frauds in healthcare costs taxpayers over $80 billion on an annual basis (Kapur 2014). Hence, the cost is estimated to increase with national healthcare spending which tops $2.7 trillion as well as cost continuing to outplace the inflation (Pittroff 2014). There has been much in the media spotlight recently throughout United Kingdom healthcare whistle-blowers. For example, the scandal-hit “Stafford Hospital” has got its fair-share of spotlight over questionable treatment of patients, which could have been avoided if the personnel involved in the procedure considered the concern increased from the staff (Henik 2015). In addition to this, a study performed by McGlynn  and Richardson (2014), indicates the fact that in the recent time NHS have observed several incidents regarding the quality of services such as poor health treatment, ignorance to patients’ request and delay in responses, which have become one of the major factor for whistleblowing and policy-making.

Another significant example in the study performed by Ko and Hur (2014), reveal the fact that Harold Shipman, a general practitioner murdered at least 215 of his patients in 24 years before his actions were eventually found in 1998. In addition, in most of the cases are in UK spotlight recently, thereby, the organizations form their own norms aligning with the similar situations (Birtch, Chiang and Van Esch 2016). Eventually, two funeral directors have made the situations to share and reveal their concerns with the general practitioners. Lately, the limelight is particularly falling on the deaths of hundreds of patients at Mid Staffordshire NHS foundation Trust as well as mistreatment in other care facilities (Newdick and Danbury 2015). So, there has to be a handful of whistle-blowers coming up with the concerns about the patient care. Nonetheless, in return, these whistle blowers do not seem to be receiving the support they should receive. Employees blow the whistle, on a frequent basis, are publicly accused of forgery or scamming, fired and some subsequently agree to a modest pay off with adequate clause to protect themselves from professional and personal damage. In this context, Kurtessiset  al. (2017) commented that there should be a complete focus on protecting United Kingdom whistle-blowers.

Furthermore, a study performed by Kapur (2014), when the unscrupulous activities like Mid-Staffordshire take places, which results to patients have the most unpleasant experience during the care. Therefore, in such context, it is highly important that employees get the feeling that they can increase concerns or blow the whistle when they observe poor quality or unsafe care. Thus, all NHS firms are needed by the law to have policies particularly in place to support employees to increase the concerns but in the recent time hospital scandals as well as the findings of many surveys have demonstrated that for some particular reasons, many other employees feel hindered in increasing concerns. On the other side, (Department of Health, 2014) performed a research on the factors of whistle blowing and they discovered that in fact the potential whistle blowers are motivated by a particular desire to defend other individual or the society in an usual basis and the author has also mentioned about some particular causes leading to whistleblowing.

• The individual has a clear evidence that organization or someone in the company is involved in the activity that is seriously wrong or holds a high potential for making a serious harm
• The alternation in the process to be made is accurate and it is possible to substantiate the accusations against the individuals
• Reasonable endeavour to avert the wrong through internal consultation and reporting are made and failed. So, the respective whistle-blowers need to attempt the use of methods of reporting within the organization barring the decision of going outside despite the delays internal mechanism may sometimes cause.

Thus, when these conditions are effectively met, blowing the whistle could be considered an ethical responsibility.

As put forward by Newdick (2014), all health professional need to be able to increase concerns regarding quality of care without any challenges such as cultural and cultural. When a professional working in the NHS is aware of the fact that care is threatened, or dangerous for whatever reason, they have a duty to make these concerns known and those to take the responsibility to evaluate it when necessary. Such technique is known as raising a concern as well as the duty of a doctor to do so is stipulated by General Medical Council (GMC). Organizational setting under NHS have examined the best practices which according to Glasper (2016), need to be reflected throughout the NHS and social care sector to deal with the barriers reported and to establish an open environment were complaints and concerns are observed as an opportunity to enhance patient care. The NHS Constitutions, which applies to England mentions about three core expectations related to whistle blowing.

• An expectation that employees should raise concerns at the most earliest opportunity
• A pledge that NHS firms should support employees by ensuring their concerns are proper investigated as well as that there should be someone outside of their team for speaking
• Transparency  around the existing legal right for employees to increase concerns regarding safety, malpractice and other unethical and illegal activity

As put forward by Pope (2017), such expectations should be supported throughout United Kingdom through adequate time and resources.

• A particular focus on patient safety and continuous enhancement to change perceptions around increasing concerns and whistle blowing as well as support and encourage people to do the same  (Henik 2015)
• A proper action by NHS leaders as well as supervisors to develop an open and safe environment in which employees could discuss and increase concerns and the patient care is processed and the requirement to whistle blow is reduced  (Kapur 2014)
• The requirement to increase concern and whistle blow as well as to protect the right of others who do the same, need to be reflected in NHS contacts
• The employees of NHS and social care setting need to know their rights, responsibilities and techniques with respect to raising concerns and whistle blowing, which means there should be a transparent structure to be increased and to make sure that the high priority is provided to check a proper response
• Individuals who increase a concern or blow the whistle are not supposed to fear recrimination and should have supported throughout the process and thereafter make sure that they do not become isolated. There need to be transparency with respect to how concerns and whistle blowing incidents have been managed.

The existing studies have provided multiple facts about whistle blowing, its process, impact and consequences. However, the findings of the studies are quite generic which means that studies did not provide or mention about any real-world facts and findings related to whistle blowing in an organizational context. Moreover, the existing studies did not mention or consider the facts of organizational justice and organizational climate and culture. A study performed by Henik (2015) has mentioned the fact that perceived support from top level of management and the supervisors anticipates helps in understanding when and how the whistle is to be blown.  However, there is contradiction that on the basis of social exchange theory, which tells that greater level of supervisor support leads to norms of reciprocity which improves trust in the medium and the supports of supervisors can lead to unethical practices (Alvesson and Sköldberg 2017). However, this is often related to internal organizational environment such as culture and climate but the studies did not pay required attention to this context. On the other side, in health care sector, organizational policies and norms are inevitable due to large variety of services; so, the chances of violating rules and wrongful activities are certain to happen but the studies only have theoretical views about such context. Eventually, it can be mentioned that inclusion of an experimental analysis would have unveiled the contemporary issues or the facts leading to whistle blowing (Henik 2015).

This chapter provides particularly discusses the research methods, approaches and designs intensively highlighting particularly those used in the study with the justification of choices through explaining the advantage and disadvantages of each approach and design considering real-world applicability to the study. According to Alvesson and Sköldberg (2017), methodology as the shape which is associated with a specific set of paradigm assumptions which is applied to perform the research. The methodology used in the study is the most appropriate to accomplish objectives of the study and it can replicate the methodology used in the study of the similar type.

Research Philosophy is mainly associated with the source, nature and development of knowledge. In a simple sense, research philosophy remains as the belief about the ways in which data regarding a phenomenon need to be collected and used. In this context, Edson, Henning and Sankaran (2016) commented that resolving this research philosophy in the research work requires awareness and formulation your belief and assumptions. There are three different types of research philosophy such as positivism, interpretivism and pragmatism. According to Flick (2015), who are positivists or believe in positivism views the world as real, independent, where organizations remains as discrete entities. Positivism research philosophy mainly drives knowledge development through the generation as well as testing of hypotheses, which further leads to creation of validated patterns of evidences. On the other side, interpretivism views the world as different from the natural world and socially constructed in which the business setting or the organizations remain as the product of dialogue. As put forward by Panneerselvam (2014), promotes a philosophy of meaning and considers the account of reality as socially negotiated. However, in the present study, positivism research philosophy has been used.

Positivism research philosophy has been selected in the present study because it provides primacy to numbers and statistical modelling to generate quantifiable as well as generalizable conclusions, which could form the ground for scientific regulations. In addition, the data on whistle blowing and organizational structure of NHS collected through secondary collection methods have been judged against the criteria of validity, reliability and generalizability. On the other side, interpretivism research philosophy has not been used to the study because under interpretivism research philosophy research findings are judged against the criteria of meaning as well as casual adequacy (Alvesson and Sköldberg 2017).

Research approaches are usually divided into three different types –namely deductive research approach, inductive research approach and abductive research approach. According to Creswell and Clark (2017), the application and the relevance of hypotheses to the research is the major distinguishing fact between the deductive and inductive approaches. According to Taylor,  Bogdan and DeVault (2015), deductive research approach verifies the validity of assumptions while inductive approach contributes to the emergence of new theories as well as generalizations. Conversely, abductive research begins with “surprising facts” and the technique of the research is devoted in the explanation. However, in the present study inductive research approach has been used.

The present research uses inductive research approach because inductive research approach does not involve the establishment of hypothesis while deductive research approach has been rejected, as deductive research requires the formulation of a set of hypotheses for the dissertation that should be confirmed or rejected. This means the research questions such as the factors leading to whistle blowing in NHS has been achieved while applying the process to the research (Alvesson and Sköldberg 2017). In addition to these two, abductive research approach has been rejected because the research technique is particularly devoted to the explanation of incomplete observation which may appear to be a challenge in deriving the insight about whistle blowing in the organization.

According to Vaioleti (2016), research design remains as the choice between qualitative and quantitative research method; while mentioned Panneerselvam (2014) mentioned that research design is referred to the choice of particular method of data collection and analysis. Research design is divided into two different groups such as exploratory and conclusive. According to Ledford and Gast (2018), exploratory research mainly focuses on exploring the specific elements of the study area and this research design does not aim to provide final and conclusive responses to the research questions. On the other side, conclusive research design known as descriptive research design is usually applied to findings that are particularly relevant and leading to decision-making. Conversely, deductive research approach is mainly concerned with development of hypotheses on the basis of existing theory. The current study uses conclusive research design because this sort of research objectives and data requirements is usually clearly defined.

As put forward by Flick (2015) data collection is the technique of gathering information from all useful sources to find responses to the research issue and evaluate the outcome. Data collection techniques can be divided into two different categories namely secondary data collection and primary data collection technique. However, only secondary data has been used in the present study (Bourne et al. 2015).

As mentioned by Alvesson and Sköldberg (2017), secondary data is a type of data that has already been issued in books, newspaper, journals and online portal.  There is a plenty of sources of data available in such sources in terms of the research area in business studies, irrespective of the nature of the study. In the present study, the secondary data has been collected from books, peer-reviewed journals, NHS historical records, healthcare journals and online reading sources. However, there is a criteria of selecting the secondary data, which is supposed to be used with in the study, which plays a great role in terms of the level of research validity and reliability (Bourne et al. 2015). The secondary data has also been collected to keep relation with the literature found. Here, the secondary data has particularly been collected to involve the relevant literature and investigate the organizational structure of National Health Setting as well as the history of whistle blowing to conceptualize the study.

As the study includes a broad and contemporary context, an in-depth analysis is required to achieve the aim and purpose. Subsequently, the interpreted data has been analysed with the findings discovered in the literature review (Alvesson and Sköldberg 2017). Each fact has been aligned with prior evidence gathered in the literature. As the study includes qualitative analysis, data has been analysed by applying a narrative analysis methods in which the reformulation of stories presented by the respondents have been considered. The method includes different experience and case of each respondents. Likewise, the case and experiences have been linked to the literature to find the relation of any particular occurrence related to whistle blowing.

Ethical grounds are the most the significant consideration in the research when it includes a primary analysis. The study only includes a secondary analysis and the data has been collected from a wide open sources. Thus, to avoid the ethical issues in the study, the researcher makes sure that data collected from the NHS departments have only been used for the academic purpose. The data has not been published in any other public medium.  In order to keep the data secure and confidential, the principles and guidelines of Data Protection Act 1998 have been followed. Moreover, the anonymity of the individuals and organizations taking part in the study have been ensured properly (Alvesson and Sköldberg 2017).

Even though, the study is performed on broader context, there is a lack of previous studies in the area. The previous studies lack the empirical findings and the number of studies used in the review is also less. An intensive review of literature would have helped to learn several facts of whistle blowing, which would have provided a vivid idea of the practice of whistle blowing in the organizations. Although, many studies have been performed on the whistle blowing but the current study required a contemporary as well as evolving research problems because a health care sector is dynamic with respect to services and internal operation and incident of whistle blowing is inevitable. So, contemporary facts would provide a more clear idea about whistle blowing.

This chapter of the study presents the secondary data that have been collected by books, journal articles and newsletter of few organizations under the National Healthcare Setting. The qualitative data has been collected from the interview with the senior organizational members of NHS provided in the journal articles. A thematic data analysis process has been applied by creating 8 different themes based on whistleblowing and its impact on the employees of the organisations under NHS, UK.

Andon et al. (2016) commented that there is a state of possibility that the development of an appropriate organizational culture, where  organizational members’ or the service users voices are heard and the practice of whistle blowing lead to improved patient safety remains as “Laudable if Elusive goal”.

There is a state of doubt that whistle blowing remains a laudable attempt, even though interestingly, there is a scarcity of areas in the existing papers where the scholars have mentioned that whistle blowing leads to safety of patients. Thus, there remains indirect evidences only that supports the argument that a white blowing culture could be laudable, consisting most of the retrospective analysis of several cases where the safety fails, as whistle blowing has been ignored. It has been identified that such retrospective analysis could normalize whistleblowing work to be conducted to make sure and demonstrate that whistle blowing creates safety prospectively instead of belatedly learning from the whistle-blower once the harm is taken place. On the other side, the data gathered from the National Healthcare Service organizations, indicates the role of the general medical council (Alvesson and Sköldberg 2017).

This means in NHS, professional bodies could strengthen their members’ natural reluctance to blow whistle by manufacturing disciplinary codes which could introduce the additional challenges.  According to Bourne et al. (2015), a doctor of the professional skills, knowledge and qualification can identify such reluctance in the “Blue Book” that talks about the depreciation. The author has mentioned that there have been many cases, which prosecuted that the doctors who escalated the legitimate concerns and there are rules under NHS’ regulatory and professional bodies. The rules made by the regulatory bodies confirm the fact that the criticism of colleagues could be somehow unacceptable.  Nonetheless, in this context, Campbell and Göritz (2014) mentioned that employees in the primary care organizations might feel unable or they might find it difficult to raise their voice without being traced and this happens due to their size as they could be much smaller than a Hospital Trust. According to this author, the management of the organizations could develop an internal relationship as well as a real challenge to employment could appear to be a significant issue and this is probably the reason of not escalating the issue.

According to the data provided in the newsletter of the Queslett Medical Centre, one of the service users has mentioned that he reported clinical concerns as well as raised the issue of bullying and no proper action was taken. “They were investigated but did not consider me as the complainer. A report was made and nothing actually happened”. The user has also mentioned that “I still have serious doubts regarding the safety of blood transfusion service at my end” (Queslettmedicalcentre.nhs.uk.2018). Hence, the whistle-blowing policies of Queslett Medical Centre say it helps to protect the right of its patients by delivering a means for its employees when identifying any doubtful malpractice, and any sort of failure at the malfunction that could put the patients in risk. Such issues remains in some organisations under NHS Lui (2014) performed anexperimental study through interview and survey and found that almost 42% of the respondents agree such concern continues today while 38% of the respondents have mentioned that they do not think such concerns can exist till date while 20% of the respondents have no clue about such issue. However, in the literature review, Pittroff (2014) mentioned that practice of whistle blowing is not old cliché; this means with the expansion of business or the organization, internal work practices also differ.  So, when the organization expands in terms of capacity, chance of unscrupulous activities also increase because there are different levels of work practice departments and each department is having increasing number of employees. It is possible that some employees or departments may not comply with the policies and they take advantages of the systems.

In addition to this, poor quality of service in the healthcare setting, deliberate mistake in treating the patient are also considered as unethical activities; thereby, Prassl (2014) mentioned that major  challenge that a large organization find is arrangements of training and development programs and supervisions. According to this author it could be difficult for a large business to supervise the operation of each department as reporting and supervision takes plenty of time. The healthcare organization “Stafford Hospital” as mentioned in the literature became the victim of the scandal as the quality of service at the lower level was not monitored properly. It is identified that the means for the above procedure is presented through the “The PublicDisclosure Act 1998 and it is usually referred to the whistleblowing (Bashir et al.2011). According to the organizational policy a failure or malfunction which is considered to presently occurring has occurred earlier and likely to take place in the future will not be endured and the events may include “any criminal offence, any sort of breach of legal obligation, a miscarriage of justice and endangering the health and safety of any patient or worker”.

A study performed by Bowen,  Call and Rajgopal (2010) mentioned that when an organization tends to follow a tall organizational structure, they usually do not pay much attention to the incidents that occur in the lower or middle level. In the case of National Healthcare Setting, issue of unethical or unscrupulous activities go often unnoticed. There are different departments and organization under the settling, thus, for an individual it is difficult to convey the concern to respective authority. Moreover, if any of the departments violate the rules, it takes a lot of time to identify the issues. It is identified that the “Public Interest Disclosure Act of 1998” passed to keep the safety of whistle-blowers against the case of Bristol Paediatric surgery scandal have not been effective as considered (Ashton 2015). In addition to this, in 2003, according to the European Commission whistle-blowers can play a great role in the debate against corruption urging the Member State to deliver protection for them but adequate advocacy has not been followed. On the other side, the recent investigation of the CNEP Trials in “Stoke on Trent” have increased the issue of vexatious whistle blowing which may engage parents and external media. A study performed by Bourne et al. (2015) have mentioned the fact that whistle blowing in National Healthcare Service always remains as traumatic undertaking and it is usually not to be recommended. There is a limited amount of evidence ethically sound disclosure, which is morally and legally justified and developed to enhance outcomes for the safety of patients providing the requisite care.

As National Healthcare Service is a large setting, organizational policies and norms are also strict enough to monitor such issues. If the complaint is filled to the right authority, the solution can be derived. However, it is difficult for the employees in the general level to learn about such actions as there are different layers of management and the personnel working in the top level of management usually share the issue with the employees. Thus, it is certain that employees will not know about whether actions are taken to address the issue (Kapur 2014). Moreover, in the literature review, it was studied that when an individual blow the whistle for a particular activity, the authority is required to perform a detailed investigation and involve authorized individuals to examine the issue. So, it is a time-consuming process and the individuals tend to ignore due to their loss of time and effort.

An experimental study performed by Pittroff (2014) has provided the fact that whistle-blowers protection mechanism must include a significant channel based on which protected disclosure can be arranged in place.  Such mechanism may include disclosure occurred from internal and external environment of the organization to a designated authority. For example, the regulation 3 made by NHS is supposed to prevent an organization under NHS from discriminating against an applicant as it appears to the NHS employer the applicant made a protected disclosure. So, to create effect that the draft states that “Prohibition of discrimination because of protected disclosure. An employer under NHS should not discriminate against an application as it appears applicant made a protected disclosure”(Prassl 2014). Thus, for this purpose “protected disclosure” is described by Section 43A of the Employment Right Act 1996, which indicates by relating the potential complaint of discriminations to whether it “appears” to  the NHS organization than an applicant made a protected disclosure, issues could be raised under the perspective NHS organizations as to the veracity or otherwise of the protected disclosure.

In addition, NHS Greenwich Clinical Commissioning Group tends to make sure that employees should feel empowered as well as supported to increase concerns effectively as well as promote culture of openness and transparency at all ranges. In addition, findings of a public inquiry into Mid-Staffordshire NHS foundation Trust demonstrate the effect of catastrophe when concerns are not escalated or treated effectively (Kapur 2014). In response to the suggestion of the public inquiry into Mid-Staffordshire NHS Foundation, NHS Greenwich Commissioning Group paid attention two significant areas: ensuring that all providers of NHS care services are adequately delivering safety standards and focus on listening to patients and staff working inclusively as the organizational member (Pyper 2014).

According to Public inquiry report on the organizational bodies of NHS, the Secretary of State for Health disclosed a series of measures to develop and deliver protective measures to existing safeguards for whistle blowers in the “Public Interest Disclosure Act 1998”.  The amended laws of NHS asks to insert an expectation that employees of National Health Staff could raise the voice about safety, malpractice doing at work which could affect patients, the public and other employees  or the organizational bodies as the whole as early as possible (Pyper 2014). This law particularly create an awareness that employees should not back off when a wrongful activities take place in the workplace. In addition to this, the amendment also talks about an insertion to support all employees in raising concerns regarding safety, malpractice or any unscrupulous activity in the workplace by responding to and where required investigating the concern raised”.  A study mentioned in the literature review by Pope (2017) reveals this similar fact that laws and regulations remain as the procedural action but the most significant thing that employees should consider is, their own action at the initial stage.

The employees at National Healthcare Setting, usually do not prefer to raise the voice or blow the whistle because they are different layers of management and NHS is a large setting; thereby, the individuals find it difficult to decide which authority they need to reach to raise the issue. On the other side, Francis (2015) mentioned that by considering the actions of investigation and internal threat from other authorities, employees usually do not prefer to raise the issue. Employees have the fear of losing their jobs. Moreover, employees find it difficult to raise the concerns because when wrongdoings or unethical activities take place in the workplace, it is certain investigation may include media exposure which is the question of self-image, which means individuals have the concern of being a victim in the limelight. One of the social workers of Queslett Medical Centre has mentioned that employees, due to fear of losing jobs and difficulty of preparing for another job, do not want their employers to be investigated by regulatory department and publicized by the news media (Cho and Song 2015) . An existing study performed by Lui (2014) mentioned that with a growing number of participants geared up to start looking for another job if their employers were to become involved in a major scandal. A manager working at the operational department of Queslett Medical Centre mentioned the fact that ethical standards are not enhancing as employees tend to receive mixed messages from management and the senior managers or the managers at the higher level are not able to consistently encourage as well as enforce complaint conduct (Queslettmedicalcentre.nhs.uk.2018). The author of this article has also highlighted the fact managerial practices also remain as the barrier to employees when reporting about the wrongdoings. For example, although the employees observe their employees saying no to bribes, the same managers might avoid the unethical behaviour of employees if their actions contributed to achieve the corporate objectives.

NHS and the government together needs to amend the policies of maintaining ethical behaviour in the workplace (Ciasullo, Cosimato and Palumbo  2017). It is certain that in a large organizational setting, the managers, supervisors and other parties tend to take advantage of the system. However, the regulatory bodies of the setting need to implement a transparent supervisions and inspection policies. For example, currently, there is a limited number of authorized members in the Board of NHS. Thus, as UK government should assign more members in the board or they need to change flat board structure by making a horizontal one. This means if one board executive is currently supervising 100 managers, it should be broken down to 25 managers under one board executive. This might help to increase the frequency of supervision and inspection (Francis 2015). On the other side, senior manager of the senior manager of NHS has mentioned that organization needs to research, develop and document and these policies should be articulated in the employee handbook; thereby, the protection need to be place in for those who raise the voice against the unethical activities (Guerciet al. 2015). So, the authors have highlighted the fact that if the frequency of supervision and inspection increases and implementation of the policies are ensured on a regular basis, the organizational members at the general level gather the confidence to raise issue to concerned departments.

According to the executives of National Health Care Setting converting whistle-blower protection into legislations validates and structures the techniques under which the whistle-blowers could reveal the wrongdoings all sort of organizational setting (Jacksonet al.2010). This statement is quite similar to the fact found in a study performed by Jones (2016), in which the author has mentioned that legislations should be prepared in a way that it protects the whistle blowers against the retaliation. So, if the legislations are implemented properly, it is certain that protection of whistle blowers could become a significant tool to promote and support the anti-corruption initiatives.  Another respondent of the above mentioned study has mentioned that “Protection of whistle blowers should be provided for particular provisions in variety of regulations like the criminal code, labour regulations and laws on prevention of bribery and negligence of care”. However, such regulations at NHS have already been formed, as one consultation, protecting whistle-blowers made the guidelines that “employees should be given the right to complain to an employment tribunal if they are discriminated against, as it appears they have previously blown the whistle” (Aol.co.uk 2018).

There is a large categories of illegal activities occur in the workplace. It is quite certain that when an organisation has multiple departments, scope for unethical or unscrupulous activities is also high. In the literature it was found that when an organization does not have strict HR policies related behaviour and ethics, the chances of wrongdoing related to unethical or illegal activities remain high (Cho and Song 2015). However, as mentioned earlier, when an individual is working for many years in an organizational setting can hold the maximum authority and members under such individual are supposed to follow the commands. On the other side, people who are working as the general departments have the less to observe such unethical activities; thereby, the percentage of individuals have not witnessed the above mentioned activities is high. The findings clearly indicates that employee tenure in healthcare setting is long (Lavena 2016). Therefore, when an individual is working with the organization for a long time, it is certain that the individual knows about the internal policies and procedures and their way out. On the contrary, it is worth mentioning that when an individual is with the setting for a long time is supposed to gain much knowledge about organisational norms and policies. Consequently, that person complies with the policies can help others to do the same.  Hence, the risk of unethical or illegal activities in the workplace is less. However, a study by Mannion and Davies (2015) in the literature review, mentions the fact of organizational climate, where the senior member or the supervisor holds maximum authority and he/she can restrain the individual from raising the issue for their own interest. Furthermore, when illegal or unethical activities take place in an organization’s environment, especially in a healthcare setting, employees at each department are certain to be involved in the case. So, the occurrence of unethical activities can take place inside or outside the business. This particular fact is quite related to the fact found in the literature. Lavena (2016) mentioned the fact that whistle blowing could often take place due to culture and climate of the organization. Thus, if an organisation’s structure is broad in terms of departments, the scope for unethical practices are also extending.

Conclusion

In conclusion, it can be mentioned that healthcare workers throughout their careers could observe several incidents related to unscrupulous or unethical activities. The review of literature and the data findings indicate the fact that some occurrence could result in serious harms occurring to others while sometime such threats could result in minimal harm- where harm is avoided at the last minute. The findings indicate the fact that in spite of fact that organizations encouraging staffs to “speak up” regarding such threats, the healthcare system internationally struggle to involve employees to do the same. In some particular cases, where the employees raise the concerns, those with the authority to listen and respond ignore them often (Lavena 2016). However, in a general sense, it can be mentioned that the organizations under NHS should learn how to create and the conditions where employees tend to raise concerns as well as respond to concerns is essential in generating a continuous and responsive learning culture which cherishes keeping patients as well as employee safe.

Background in the introductory section talks about tortured history in National Health even though it has been identified by authoritative reviews as making an essential contribution to safety of the parties involved in the organization. Several studies in the literature review have mentioned an integrated definition that whistleblower is a person who raise the voice against the wrongdoings (Mannion and Davies 2015). The review of literature also indicate the fact that in National Healthcare Setting, the regulatory bodies could reinforce their members’ natural reluctance to whistle blower by generating disciplinary codes which provides additional codes. The major purpose of the report was to understand the degree of impact of whistle blowing in organisation learning. The objective was to determine the impact of whistle blowing on organizational members.  In the literature, it was found that there is possibility that employees during their work period may come across several unethical or unscrupulous activities but due to the ignorance of senior managers or the departments at the higher level, the employees at the general refrain from raising the issue to the concerned authority. The secondary data has been gathered for the analysis which leading to the fact that NHS in the recent time have made several amendments in the existing laws. Data gathered from the interview analysis performed by the scholars tells the fact UK government should assign more members in the board or they need to change flat board structure by making a horizontal one. This is done to increase the frequency of inspection with purpose of preventing unscrupulous activities. Although, there has been several laws and governments initiative, preventing unethical or any sort of wrongdoing in the workplace could be difficult, unless there is a frequent inspection on the context.

The findings imply that National Healthcare Service in United Kingdom, due to lack of initiatives of employees towards whistle-blowing, has made several amendments in the existing laws to protect the employees for whistle blowing. Nonetheless, due to lack of inspection and poor knowledge of employee regarding the initiatives, any sort of wrongdoing activities do not come in the limelight. The following suggestions have been provided to lead or guide employees towards such initiatives (Mannion and Davies 2015).

Conduct training: The organizations under National Healthcare Service should teach managers and employees about how to treat or deal with the concerns without the fear of retaliation. This means that organizational bodies under NHS, to create awareness, need to provide employees with appropriate training regarding how to raise the concerns about the wrongdoings, when and whom to report the issue (Lavena 2016). There should be one or two specific authorized bodies in the organization who will supervise such as across the organization. When the employees know the specific bodies where they report issue, they do not have to invest unnecessary time in finding which authority they will report to. In addition, the organization also needs to make their employees understand developed “hotlines are safe to raise concerns”.

Provide financial incentives: It was found in the literature and findings that employees have the barrier to raise the concerns as due to their self-belief and fear of losing their job position or causing self-harm. In response to this issue, the organizations need to develop a reward system where employees will get incentives for valid whistle-blowing.  This reward system not only lessen the fear of organizational members of retaliation, it might give them a financial inducement to develop (Lavena 2016).

Get endorsement from top management: The top level management starting with CEO, need to demonstrate or convey a strong commitment for encouraging whistle blowing. Such message of commitment should be communicated by the line managers at all levels, who are trained persistently in generating an open-door policy about employee’s concerns regarding the wrongdoings in the organizations.

References

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Alvesson, M. and Sköldberg, K., 2017. Reflexive methodology: New vistas for qualitative research. Sage.

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