Professor Russell Mannion (HSMC) and Professor Huw Davies (University of St Andrews) have published an editorial in the International Journal of Health Policy and Management on approaches to understanding and researching whistleblowing in health care organisations.

Healthcare scandals in many countries provide tangible evidence of the significant shortcomings in the protection and support offered to whistle-blowers even when they raise legitimate concerns: healthcare organisations frequently disregard such concerns and provide inadequate responses to the issues raised. In some cases, it is clear that senior players seek to ostracise and isolate individuals by undermining their concerns; in extreme cases, healthcare professionals have been disciplined, suspended or reported for misconduct to professional bodies on pretexts derived from a very particular and partisan reading and framing of events. Much thinking about whistle blowing misconstrues it as something separate from normal organisational functioning, and so misses a broader opportunity to consider voice and silence in the round in organisational settings.

Whistleblowing, in our view, sits as part of a wide spectrum of formal and informal behaviours that are embedded in local organisational context and cultures, and enmeshed in both formal and informal governance arrangements and practices. Central here is the ambiguity of judgements and practices that are shaped by clashing discourses, discourses that in turn are shaped by local interests and power relations. Creating the right organisational environments where voices can be aired, divergent narratives can be acknowledged, and (even in the face of ambiguity) effective action aimed at better safer care can be enacted, remains the laudable, if elusive, goal. Whistleblowing can be a part of this, but it needs to be understood with due cognisance of the wider organisational setting, and not seen as something somehow separate and different, a ‘bolt on’ addition.