What are people's attitudes toward medical insurance fraud whistleblowers? a study from China.

PURPOSE: Medical insurance fraud has caused huge losses to countries around the world, and public reporting has become an important means to combat medical insurance fraud. The attitude of medical insurance fraud whistleblowers affects people's reporting behavior, and understanding people's attitude toward medical insurance fraud whistleblowers provides a basis for further improving the system and policy of public participation in medical insurance fund supervision. METHODS: We adopted the questionnaire method to conduct a national cross-sectional survey of the Chinese public and analyzed the data using Chi-square tests, Fisher's exact tests, and binary logistic regression models. RESULTS: A total of 837 respondents were included, and 81.8% of the population had a supportive attitude toward medical insurance fraud whistleblowers, with gender, whether they had used medical insurance reimbursement, and present life satisfaction being statistically significant (P < 0.05). CONCLUSION: The public is generally supportive of medical insurance fraud whistleblowers, and women, those who have used medical insurance for reimbursement, and those who are satisfied with their lives are more likely to be supportive of medical insurance fraud whistleblowers.

The relationship between ethical position and whistleblowing: A cross-sectional study among nurses.

AIM AND OBJECTIVES: The aim of this study is to determine nurses' ethical positions, whistleblowing intention and its causes, and to analyse the correlation between them, while revealing the personal and professional characteristics causing significant difference. BACKGROUND: In today's challenging healthcare settings, ethical dilemmas are inherent to nursing practices, leading to situations whereby nurses must consider whistleblowing and reasons such as reporting medical errors or misbehaviors. DESIGN: The study is descriptive, cross-sectional and correlational. METHODS: The data were collected from a convenience sample consisting of 294 nurses between 1 April and 30 June 2019, in four hospitals in two cities. An introductory information form, Ethics Position Questionnaire, Whistleblowing Scale and Causes of Whistleblowing Scale were employed to collect data. The data were analysed with descriptive, correlational, comparative and internal consistency analyses (Guidelines for reporting cross-sectional studies (Data S1)). RESULTS: It was found that nurses encountered (31.3%) and reported (85.9%) unethical incidents. According to the subscales, they obtained higher scores from idealism (4.37 ± 0.52), supportive whistleblowing (3.75 ± 0.72), and moral and professional values (3.77 ± 0.67). The Ethics Position Questionnaire, as well as the Whistleblowing Scale (r = .302) and the Causes of Whistleblowing Scale (r = .211) had a positive weak correlation (p < .001). Nurses' age, marital status, and professional and institutional experiences all created a significant difference (p < .05). CONCLUSIONS: The nurses mostly encountered unethical incidents associated with management. The rates of reporting the unethical incidents were high, and they were found not hesitating to report using whistleblowing, yet intended to keep the incidents within the institution. In addition, idealistic nurses were more likely to whistleblow, and their causes for whistleblowing were mostly associated with moral and professional values. RELEVANCE TO CLINICAL PRACTICE: It is recommended that nurses' ethical position, and whistleblowing intentions and causes should be supported and improved through the corporate culture.

Reasoning for whistleblowing in health care.

BACKGROUND: Whistleblowing is recognised as part of solving wrongdoing. It requires individual reasoning as it is a potentially complicated process with a risk of possible negative consequences for oneself. Knowledge on how individuals reason for whistleblowing in healthcare context is lacking. AIM: This study aimed to create a theoretical construct to describe individual reasoning for whistleblowing. METHODS: The methodology was grounded theory, with 244 nurses as informants. The data consisted of nurses' written narratives in response to a wrongdoing situation presented in a video vignette. To ensure the heterogeneity of the population and variation in nurses' professional expertise, experiences and geographical locations in health care to capture the multidimensionality of the responses, nurses were invited to participate, and data were collected electronically from the membership register of the Finnish Nurses' Association on a national level. Constant comparison was used to analyse the open data. RESULTS: The core category of the theoretical construct, 'The formation of morally courageous intervening', was discovered, reflecting individual's values and beliefs. It forms mentally as an integration of cognition and emotion for recognising one's own strengths and limits to act to do the right thing despite the risk of negative consequences for oneself. The core category consists of three dimensions of reasoning: (1) Reasoning Actors, (2) Reasoning Justifications and (3) Reasoning Activities, their categories and three patterns of reasoning connecting the dimensions and their categories with each other: (I) Individual Reasoning, (II) Collaborative Reasoning and (III) Collective Reasoning. DISCUSSION AND CONCLUSION: The theoretical construct indicate that reasoning is a multidimensional phenomenon. In future, a theoretical construct could be further developed. In health care, managers could use the theoretical construct to support employees in their whistleblowing.

New Insurance Product Needed for Physicians: Coverage for Sham Peer Review and Hospital Immunity.

This commentary article highlights the need for an insurance product for hospital-employed physicians that provides coverage against sham peer review and a complete defense against wrongful hospital allegations of incompetent, whistleblowing, or disruptive behavior.

Addressing Clinical Misconduct: Resigning and Whistleblowing in Clinical Ethics Consultation.

Clinical ethics consultants occasionally encounter unethical and/or unprofessional behavior as part of their normal job functions. In this article, we explore whether resigning (i.e., threatening resignation or resigning) and whistleblowing are acceptable methods ethics consultants can use to address these situations. Per our analysis, whether one considers ethics consultants private or public employees, loyal to their employer or to patients, families, and the public, resigning and whistleblowing are all acceptable, if not obligatory, actions of ethics consultants in certain circumstances. In this article, we analyze salient characteristics of ethics consultation as a profession as they pertain to resignation and whistleblowing in the context of ethics consultation. We also present tentative criteria for when ethics consultants are justified, if not obligated, to resign or blow the whistle.

Blowing the whistle during the first wave of COVID-19: A case study of Quebec nurses.

The experiences of nurses who blew the whistle during the COVID-19 pandemic have exposed gaps and revealed an urgent need to revisit our understanding of whistleblowing. AIM: The aim was to develop a better understanding of whistleblowing during a pandemic by using the experiences and lessons learned of Quebec nurses who blew the whistle during the first wave of COVID-19 as a case study. More specifically, to explore why and how nurses blew the whistle, what types of wrongdoing triggered their decision to do so and how context shaped the whistleblowing process as well as its consequences (including perceived consequences). DESIGN: The study followed a single-case study design with three embedded units of analysis. METHODS: We used content analysis to analyse 83 news stories and 597 forms posted on a whistleblowing online platform. We also conducted 15 semi-structured interviews with nurses and analysed this data using a thematic analysis approach. Finally, we triangulated the findings. RESULTS: We identified five themes across the case study. (1) During the first wave of COVID-19, Quebec nurses experienced a shifting sense of loyalty and relationship to workplace culture. (2) They witnessed exceedingly high numbers of intersecting wrongdoings amplified by mismanagement and long-standing issues. (3) They reported a lack of trust and transparency; thus, a need for external whistleblowing. (4) They used whistleblowing to reclaim their rights (notably, the right to speak) and build collective solidarity. (5) Finally, they saw whistleblowing as an act of moral courage in the face of a system in crisis. Together, these themes elucidate why and how nurse whistleblowing is different in pandemic times. CONCLUSION: Our findings offer a more nuanced understanding of nurse whistleblowing and address important gaps in knowledge. They also highlight the need to rethink external whistleblowing, develop whistleblowing tools and advocate for whistleblowing protection. IMPACT: In many ways, the COVID-19 pandemic has challenged our foundational understanding of whistleblowing and, as a result, it has limited the usefulness of existing literature on the topic for reasons that will be brought to light in this paper. We believe that studying the uniqueness of whistleblowing during a pandemic can address this gap by describing why and how health care workers blow the whistle during a pandemic and situating this experience within a broader social, political, organizational context.

The principle of double effect and external whistleblowing in nursing.

Nurses are generally expected to raise concerns when a harm or wrongdoing is committed against patients. Should their concerns not be adequately addressed, then nurses may take the decision to engage in external whistleblowing. Given that it could have a negative effect on the health care organization or service, nurses may question whether they should engage in external whistleblowing. Consequently, is there an ethical criterion to discern whether the negative effect on the health care organization or service is ethically permissible? This paper argues for the suitability of the Principle of Double Effect as an ethical criterion. The position of this paper is that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e. the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect.

Whistle-blowers - morally courageous actors in health care?

BACKGROUND: Moral courage means courage to act according to individual's own ethical values and principles despite the risk of negative consequences for them. Research about the moral courage of whistle-blowers in health care is scarce, although whistleblowing involves a significant risk for the whistle-blower. OBJECTIVE: To analyse the moral courage of potential whistle-blowers and its association with their background variables in health care. RESEARCH DESIGN: Was a descriptive-correlational study using a questionnaire, containing Nurses Moral Courage Scale©, a video vignette of the wrongdoing situation with an open question about the vignette, and several background variables. Data were analysed statistically and inductive content analysis was used for the narratives. PARTICIPANTS AND RESEARCH CONTEXT: Nurses as healthcare professionals (including registered nurses, public health nurses, midwives, and nurse paramedics) were recruited from the membership register of the Nurses' Association via email in 2019. A total of 454 nurses responded. The research context was simulated using a vignette. ETHICAL CONSIDERATIONS: Good scientific inquiry guidelines were followed. Permission to use the Nurses' Moral Courage Scale© was obtained from the copyright holder. The ethical approval and permission to conduct the study were obtained from the participating university and the Nurses' Association. FINDINGS: The mean value of potential whistle-blowers' moral courage on a Visual Analogue Scale (0-10) was 8.55 and the mean score was 4.34 on a 5-point Likert scale. Potential whistle-blowers' moral courage was associated with their socio-demographics, education, work, personality and social responsibility related background variables. DISCUSSION AND CONCLUSION: In health care, potential whistle-blowers seem to be quite morally courageous actors. The results offer opportunities for developing interventions, practices and education to support and encourage healthcare professionals in their whistleblowing. Research is needed for developing a theoretical construction to eventually increase whistleblowing and decrease and prevent wrongdoing.

Doctors in China Need More Power of Discourse.

COVID-19 that developed in late 2019 and 2020 is a severe threat to human health. The tragedy of Dr Li Wenliang, the whistleblower, revealed a current status of doctors' insufficient power of disclosure. Therefore, prompt and effective actions warrant to be taken by the government and public to improve Chinese doctors' power of disclosure. A medical system based on the improved doctors' power of disclosure is beneficial to disease prevention in an extended period.

Whistleblowing against doping in sport: A cross-national study on the effects of motivation and sportspersonship orientations on whistleblowing intentions.

Whistleblowing against anti-doping rule violations and related misconduct has been recognized as an important deterrent of doping behaviour in competitive sport. However, research on whistleblowing against doping is scarce and the available studies have focused on small samples using qualitative and inductive approaches. The present study used quantitative methods to assess, for the first time, the association between self-determined motivation, achievement goals, sportspersonship orientations and intentions to engage in whistleblowing against doping misconduct. A total of 992 competitive athletes from Greece (n = 480) and Russia (n = 512) completed structured measures of self-determination, achievement goals, sportspersonship orientation beliefs, and intentions to report doping misconduct. Latent profile analysis classified athletes into clusters consistent with the theoretical predictions. One-way analyses of variance further showed consistently across countries that autonomous motivated athletes reported higher intentions to whistleblow, and athletes with higher scores in achievement goals and sportspersonship orientations had significantly higher scores in whistleblowing intentions, compared to those with lower scores in these characteristics in both countries. This is the first study to demonstrate the association between motivational regulations, achievement goals, sportspersonship beliefs, and whistleblowing intentions. The theoretical and policy implications of our study are discussed.

Whistleblowing Against Doping Misconduct in Sport: A Reasoned Action Perspective With a Focus on Affective and Normative Processes.

Whistleblowing against doping misconduct represents an effective deterrent of doping use in elite competitive sport. The present study assessed the effects of social cognitive variables on competitive athletes' intentions to report doping misconduct. A second objective was to assess whether the effects of social norms on whistleblowing intentions were mediated by actor prototype evaluations and group identification and orientation. In total, 1,163 competitive athletes from Greece, Russia, and the United Kingdom completed a questionnaire on demographics, past behavior, social cognitive variables, and intentions toward whistleblowing. Regression analyses showed that whistleblowing intentions were associated with different social cognitive variables in each country. Multiple mediation modeling showed that attitudes and subjective norms were associated with whistleblowing intentions indirectly, via the effects of anticipated negative affect and group identification and orientation, respectively. The findings of this study are novel and have important implications about the social, cognitive, and normative processes underlying decision making toward reporting doping misconduct.

Recognizing the importance of whistleblowers in healthcare.

ABSTRACT: Healthcare professionals who raise concerns about workplace safety or other problems should be praised as heroes and changemakers. However, some whistleblowers face retaliation for speaking out, and the incidence of retaliation cases against these employees has spiked during the COVID-19 pandemic. This article reflects on the role of whistleblowers and their importance to public accountability.