A Coordination Theory of NHS Whistleblowing Failure

2026-07-21

AI Summary

This study investigates the structural roots of whistleblowing failures within the UK’s National Health Service (NHS), moving beyond conventional explanations centered on inadequate legal protections or insufficient individual incentives. By constructing a repeated game model involving whistleblowers, hospital management, and colleagues, and solving for the unique equilibrium using global game methodology, the paper identifies three coordination failure mechanisms previously overlooked by existing policies. It proposes a novel structural framework grounded in group-level interactions that elucidates the intrinsic logic underlying the difficulty of coordinating whistleblowing behavior. This approach offers fresh theoretical foundations and policy insights for improving whistleblowing systems in healthcare organizations.

Abstract

Persistent whistleblowing failure in hierarchical healthcare organisations is typically attributed to insufficient legal protection for reporters or inadequate managerial incentives to investigate. This diagnosis is argued to be structurally incomplete. A repeated three-player game among a whistleblower, Trust management, and a colleague group is solved via global games techniques to obtain a unique equilibrium, identifying three mechanisms existing policy neither recognises nor addresses.

Problem

• whistleblowing failure
• hierarchical healthcare organisations
• NHS
• policy gaps
• organisational coordination

Innovation

• whistleblowing failure
• three-player game
• global games
• coordination theory
• healthcare organisations