Exploring the utility of internal whistleblowing in healthcare via agent-based models

Objective The benefits of internal whistleblowing or speaking-up in the healthcare sector are significant. The a priori assumption that employee whistleblowing is always beneficial is, however, rarely examined. While recent research has begun to consider how the complex nature of healthcare institutions impact speaking-up rates, few have investigated the institutional processes and factors that facilitate or retard the benefits of speaking up. Here we consider how the efficacy of formal inquiries within organisations in response to employees’ speaking up about their concerns affects the utility of internal whistleblowing. Design Using computational models, we consider how best to improve patient care through internal whistleblowing when resource and practical limitations constrain healthcare operation. We analyse the ramifications of varying organisational responses to employee concerns, given organisational and practical limitations. Setting Drawing on evidence from international research, we test the utility of whistleblowing policies in a variety of organisational settings. This includes institutions where whistleblowing inquiries are handled with varying rates of efficiency and accuracy. Results We find organisational inefficiencies can negatively impact the benefits of speaking up about bad patient care. We find that, given resource limitations and review inefficiencies, it can actually improve patient care if whistleblowing rates are limited. However, we demonstrate that including softer mechanisms for internal adjustment of healthcare practice (eg, peer to peer conversation) alongside whistleblowing policy can overcome these organisational limitations. Conclusion Healthcare organisations internationally have a variable record of responding to employees who speak up about their workplace concerns. Where organisations get this wrong, the consequences can be serious for patient care and staff well-being. The results of this study, therefore, have implications for researchers, policy makers and healthcare organisations internationally. We conclude with a call for further research on a more holistic understanding of the interplay between organisational structure and the benefits of whistleblowing to patient care

Value Homophily Benefits Cooperation but Motivates Employing Incorrect Social Information

Individuals often judge others based on third-party gossip, rather than their own experience, despite the fact that gossip is error-prone. Rather than judging others on their merits, even when such knowledge is free, we judge based on the opinions of third parties. Here we seek to understand this observation in the context of the evolution of cooperation. If individuals are being judged on noisy social reputations rather than on merit, then agents might exploit this, eroding the sustainability of cooperation. We employ a version of the Prisoner’s Dilemma, the Donation game, which has been used to simulate the evolution of cooperation through indirect reciprocity. First, we validate the proposition that adding homophily (the propensity to interact with others of similar beliefs) into a society increases the sustainability of cooperation. However, this creates an evolutionary conflict between the accurate signalling of ingroup status versus the veridical report of the behaviour of other agents. We find that conditions exist where signalling ingroup status outweighs honesty as the best method to ultimately spread cooperation