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The reporting of incidents or “whistleblowing” occurs when a member of staff within an organisation discloses that an employee has acted in a way that is a cause for concern, and the person it is reported to has the ability to do something about it. Surveys in the UK and the USA have shown that errors in healthcare are unacceptably high. It is also known that under‐reporting of errors is the norm. There is a need to understand why people fail to report so that systems and more open cultures which support staff in reporting poor practice can be introduced. Research that captures the experiences of those who have observed poor care and what they experience if they report an incident is critical to developing such an understanding. This paper aims to address this issue.

An exploratory quantitative research design, based on a similar study in the NHS UK, was utilised to answer the research questions of this study. Data were collected in eight acute hospitals in the Health Services Executive (HSE) regions in Ireland. Two hospitals were selected from each of the four regions and nursing staff on three wards within each hospital provided the sample. A total of 575 anonymous questionnaires were sent to all grades of nurses working on these 24 wards.

A total of 152 responses were received, a response rate of 26 per cent. This study found that 88 per cent of respondents, i.e. nurses working in acute hospitals, have observed an incident of poor care in the past six months. The findings indicate that 70 per cent of those that observed an incident of poor care reported it. Nurse managers are more likely to report than staff nurses (reporting rates of 88 per cent and 65 per cent respectively). The study findings indicate that only one in four nurses who reported poor care were satisfied with the way the organisation handled their concerns.

Health professionals have a responsibility to maintain standards of care and this responsibility includes taking action to report poor care. The paper shows that reporting of poor care is hampered by a fear of retribution and lack of faith in the organisation's ability to take corrective action.

Why do some healthcare professionals report incidents while others fail to do so? In a previous paper, the authors explored the culture of hospitals in Ireland and the response to those who reported poor care. In this paper the authors aim to advance understanding of reporting behaviour by exploring differences between those who report incidents and those who choose not to report.

An exploratory quantitative research design was utilised for this study. Data from eight acute hospitals in the Health Services Executive (HSE) regions in Ireland – two hospitals from each of the four regions and nursing staff on three wards within each hospital – provided the sample. A total of 575 anonymous questionnaires were distributed.

Eighty‐eight per cent of nurses working in acute hospitals have observed an incident of poor care in the past six months, but only 70 per cent of those reported it. Non‐reporters are significantly more likely than those who have reported incidents to cite “not wanting to cause trouble” and “not being sure if it is the right thing to do” as reasons for their reluctance to report. “Fear of retribution” was the most common reason given by non‐reporters for their reluctance to report.

The findings show that reluctance to report is mainly influenced by fears of retribution, not wanting to cause trouble and not being sure if reporting an incident is the right thing to do. Managers and policy makers within healthcare environments need to provide more reassurance for staff and put in place better measures to protect staff from negative repercussions that might arise from whistleblowing.

The purpose of this paper is to illustrate the complexities involved in delivering seamless patient-centred care across organisational boundaries. There is particular focus on how working with an organisation outside the public sector challenges the ideology of those involved, thereby hindering progress. It will explore the challenges and solutions to delivering a service and discuss the key components of success. It will investigate the theory of partnership working and balance the importance of the emotional investment and understanding with leadership and project management.

It explores the current “crisis” in NHS, along with political statements, emphasising its importance, but failing to address the issues faced by workers and agencies in the “outside” world. It will examine the concept of the “other” to explain the struggle required to gain a place at the table in discussing integration/service improvement. It will use experience in negotiating between a reasonably large care and nursing home provider and public sector bodies in Wales and consider the factors leading to a successful collaboration.

The Social Services and Well-being (Wales) Act, 2014 makes it clear that integration is seen as a critical means to achieve better outcomes for people and whilst not contesting that principle, the paper shows that integration is often limited in thinking and action to “public sector” integration.

There have been few attempts to explore the role and function of care and nursing home providers in service improvement from the provider’s perspective. It will challenge the practice of commissioning, that gives all the power to the commissioner and explores the commissioners’ accountability for their role in partnership work. It also offers hope for a different kind of relationship, based on mature conversations and mutual respect, along with a system of governance offering guarantees for sustainability.

Nod y papur hwn yw herio’r diffiniad poblogaidd a dderbynnir o’r GIG tra’n trafod y posibiliadau a photensial cyflenwi gofal didrafferth sy’n canolbwyntio ar y claf rhwng darparwr cartref nyrsio trydydd sector, bwrdd iechyd Prifysgol ac awdurdod lleol, gan ddangos bod y cyfleoedd ar gyfer dewisiadau amgen i wasanaethau ysbyty yn enfawr. Bydd yn cyfeirio at y diffyg dealltwriaeth a’r diffyg ymddiriedaeth cynhenid rhwng y rheiny sy’n credu eu bod yn gweithio yn y GIG neu’n rhan ohono a’r rheiny sydd wedi eu diffinio neu y’u hystyrir fel pobl sydd “y tu allan”. Os byddwch yn lleoli’r beirniadaethau gwerth a’r rhagfarn cysylltiedig gan weithwyr proffesiynol, gwleidyddion a’r cyhoedd am y byd ‘y tu allan’, byddwch yn dod ar draws rhwystrau gwirioneddol i ddylunio, cyflenwi a gweithredu modelau gofal gwahanol. Bydd yr awdur yn herio’r diffiniad o’r GIG fel y defnyddir mewn ymarfer ac yn dangos sut, trwy ganolbwyntio ar y claf a diben y GIG, yn hytrach na’r adeilad ffisegol neu’r sefydliad, gall arweinwyr gael rhyddid i fod yn arloesol ac yn effeithiol wrth ddylunio a chyflenwi gwasanaethau.

bydd yr awdur yn archwilio’r “argyfwng” a welir yn y GIG ar hyn o bryd, ynghyd â datganiadau gwleidyddol i bwysleisio ei bwysigrwydd, sy’n methu mynd i’r afael â’r materion a wynebir gan weithwyr ac asiantaethau sy’n ffurfio’r byd “y tu allan”. Bydd y papur yn archwilio’r cysyniad o’r “ARALL” i esbonio’r frwydr sydd ei hangen i gael lle wrth y bwrdd i drafod integreiddio/gwella gwasanaethau. Bydd yn defnyddio profiad yn trafod rhwng darparwr cartref gofal a nyrsio cymharol fawr a chyrff y sector cyhoeddus yng Nghymru ac yn ystyried y ffactorau sy’n arwain at gydweithredu llwyddiannus.

Mae Deddf Gwasanaethau Cymdeithasol a Lles (Cymru), 2014 yn egluro bod integreiddio’n cael ei weld fel dull hanfodol o gael canlyniadau gwell ar gyfer pobl ac er nad yw’n dadlau yn erbyn yr egwyddor hwnnw, mae’r papur yn dangos bod integreiddio yn aml yn gyfyngedig o ran meddwl a gweithredu i integreiddio’r ‘sector cyhoeddus’.

Mae’r papur yn ymgais prin iawn i archwilio rôl a swyddogaeth darparwyr cartrefi gofal a nyrsio yn gwella gwasanaethau, yn herio dealltwriaeth un dimensiwn o gomisiynu sy’n rhoi’r grym i gyd i’r comisiynydd. Mae hefyd yn rhoi gobaith ar gyfer math gwahanol o berthynas, yn seiliedig ar barch ar y ddwy ochr, ynghyd â system o lywodraethu sy’n gallu rhoi sicrwydd yn ymwneud â chynaliadwyedd.

Whistleblowing is a procedure where an existing or past participant of an establishment reveals actions and practices believed to be illegal, immoral or corrupt, by individuals who can influence change. Whistleblowing is an important means of recognising quality and safety matters in the health-care system. The aim of this study is to undergo a literature review exploring perceived barriers of whistleblowing in health care among health-care professionals of all grades and the possible influences on the whistleblower.

An integrative review of both quantitative and qualitative studies published between 2000 and 2020 was undertaken using the following databases: CINAHL Plus, Embase, Google Scholar, Medline and Scopus. The primary search terms were “whistleblowing” and “barriers to whistleblowing”. The quality of the included studies was appraised using the Critical Appraisal Skills Programme criteria. The authors followed preferred reporting items for systematic review and meta-analysis (Prisma) in designing the research and also reporting.

A total of 11 peer-reviewed articles were included. Included papers were analysed using constant comparative analysis. The review identified three broad themes (cultural, organisational and individual) factors as having a significant influence on whistleblowing reporting among health-care professionals.

This study points out that fear is predominantly an existing barrier causing individuals to hesitate to report wrongdoing in care and further highlights the significance of increasing an ethos of trust and honesty within health care.

The purpose of this paper is to highlight contemporary issues in achieving best practice in safeguarding adults across multi‐agency settings.

The paper is an empirical exploration, reviewing a range of relevant literature and recent policy to present evidence suggesting that there continue to be challenges in achieving best practice in multi‐agency approaches to safeguarding. The literature review was undertaken using the following databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, PsycINFO and Medline. The inclusion criteria included being peer‐reviewed and published between 2004 and 2012. The key words used were: “safeguarding adults” and “abuse”. Further literature was found through adopting a “snowballing” technique, in which additional sources were found from the reference lists used in the initial articles.

Although guidance such as No Secrets from the Department of Health, in 2000, emphasises the importance of a multi‐agency approach, this continues to be problematic and presents challenges. In practice, differing professionals may not fully understand each other's roles and responsibilities and both thresholds and scope of adult abuse are still not universally agreed. Legislation could be used positively to mandate the multi‐agency approach to adult safeguarding, supported by local Safeguarding Adults Boards and local policies can be used to provide guidance and clarity for practitioners. Further empirical investigation into supporting the multi‐agency approach is required.

The paper fulfils the need for discussion on the complexities and challenges that continue to present in multi‐agency responses to adult safeguarding practice.

This paper examines different perspectives on the broad umbrella term of organisational silence. It identifies ten perspectives on organisational silence from the previous literature on inquiries into failings of British National Health Service providers. The purpose of this paper is to address these issues.

Using content analysis, it applies ten perspectives on organisational silence to the report of the inquiry into the Gosport Hospital.

There is some overlap between the perspectives in that they draw on the same authors, and stress similar issues. There is some evidence for most of the perspectives in the report, but some perspectives appear stronger than others. However, none of the perspectives seem to cover the full spectrum of behaviour and place differential emphasis on different processes. It is not clear whether all ten perspectives add independent analytical value. This suggests that some might be extended or combined with the umbrella term of organisational silence more fully opened.

This is the first study in healthcare to review perspectives on organisational silence and apply them to a case study.

This study aims to evaluate the relationships between leadership style and reported incidents, reporting practices and patient safety initiatives in Kuwaiti hospitals.

This cross-sectional and retrospective quantitative multi-centre study was conducted in a secondary care setting. The multifactor leadership questionnaire and the patient safety questionnaire were distributed in six general hospitals to a sample of physicians, nurses and pharmacists. Incident reports were reviewed in each hospital to assess reporting practices.

The hospital with the most safety incident reports scored the highest on good reporting practices, whereas the hospital with the lowest score of poor reporting practices had reported fewer incidents. Reporting was better if an error reached the patient but caused no harm. Overall, reporting practices and implementation of patient safety initiatives in the hospitals were suboptimal. Nevertheless, a transformational leadership style had a positive effect on patient safety and reporting practices.

This study represents a baseline for researchers to assess the relationship between leadership style and patient safety. Moreover, it highlights significant considerations to be addressed when planning patient safety improvement programmes. More investment is needed to understand how to raise transformational leaders who are more effective on patient safety. Further studies that include primary and tertiary health-care settings and the private sector are required.

To the best of the authors’ knowledge, this study is the first in Kuwait to report on the relationship between transformational leadership and safety practices.

There are three main objectives of the research presented in this paper: to examine the challenges of using an electronic adverse incident recording and reporting system; to assess the method of using a prevention appraisal and failure model; and to identify the benefits of using quality costs in conjunction with incident reporting systems.

Action diary, documentation and triangulation are used to obtain an understanding of the challenges and critical success factors in using quality costing within an adverse incident recording and reporting system.

The paper provides healthcare professionals with the critical success factors for developing quality costing into an electronic adverse incident recording and reporting system. This approach would provide clinicians, managers and directors with information on patient safety issues following the effective use of data from an electronic adverse incident reporting and recording system.

This paper makes an attempt of using a prevention, appraisal and failure model (PAF) within a quality‐costing framework in relation to improving patient safety within an electronic adverse incident reporting and recording system.

The purpose of this paper is to examine the usability and potential of incorporating quality costs into an electronic adverse incident recording system within a healthcare sector.

The paper is a general review and a discussion of an electronic adverse incident‐recording system into the potential benefits and restrictions was undertaken. Articles containing both information systems and quality costs were reviewed in order to explore the potential of linking information against patient safety issues.

The paper finds that quality costs is a valid and useful approach for measuring the impact of individual adverse incidents or trends in order to support managers and clinicians to develop appropriate action plans to reduce levels of patient harm and thereby improve patient safety. The paper also shows that quality costs can be used to support managers and clinicians and are commercially designed to improve the detection, investigation and action planning to improve service quality and patient safety.

Quality costs can be used as a driver for identifying potential high impact quality and patient safety projects within a healthcare setting.

This paper provides useful information for designers of electronic adverse incident‐reporting systems to support managers and clinicians to utilise the benefits of quality costing in order to strengthen and re‐focus patient safety issues in healthcare.

The purpose of this paper is to evaluate the common themes leading or contributing to clinical incidents in a UK teaching hospital.

A root‐cause analysis was conducted on patient safety incidents. Commonly occurring root causes and contributing factors were collected and correlated with incident timing and severity.

In total, 65 root‐cause analyses were reviewed, highlighting 202 factors implicated in the clinical incidents and 69 categories were identified. The 14 most commonly occurring causes (encountered in four incidents or more) were examined as a key‐root or contributory cause. Incident timing was also analysed; common factors were encountered more frequently during out‐hours – occurring as contributory rather than a key‐root cause.

In total, 14 commonly occurring factors were identified to direct interventions that could prevent many clinical incidents. From these, an “Organisational Safety Checklist” was developed to involve departmental level clinicians to monitor practice.

This study demonstrates that comprehensively investigating incidents highlights common factors that can be addressed at a local level. Resilience against clinical incidents is low during out‐of‐hours periods, where factors such as lower staffing levels and poor service provision allows problems to escalate and become clinical incidents, which adds to the literature regarding out‐of‐hours care provision and should prove useful to those organising hospital services at departmental and management levels.