Guest blog by Dr Henrietta Hughes OBE – National Guardian, National Guardian’s Office
Freedom to speak up is a core component of a healthy organisational culture where workers are confident that they will be listened to if they raise any issue and that they will be supported to ‘do the right thing’.
No matter what sector we work in, we all have a responsibility to encourage an environment where speaking up and listening up are business as usual. A supportive Speak Up culture is one where all of us should be able to speak up about anything; whether we are board members, leaders, workers or students, knowing that the right actions will be taken is vital. We should be able to share ideas, seek advice, offer feedback, challenge decisions, or raise concerns without fear of repercussions.
Following the events at Mid Staffordshire NHS Foundation Trust, Sir Robert Francis made recommendations in 2015 that every NHS Trust and Foundation Trust should have a Freedom to Speak Up Guardian. This was borne out of hearing evidence from NHS workers who had spoken up previously about patient safety and either been ignored or suffered bullying or intimidation for trying to raise concerns. Freedom to Speak Up Guardians are there for students on clinical placements and for trainees, providing a confidential route to raise concerns if individuals do not want to speak to their supervisor or manager, for whatever reason.
Freedom to Speak Up Guardians act independently and impartially to support all workers to speak up and remove barriers to speaking up. Guardians are an additional channel, often used when workers are not confident to speak up through the usual routes such as their line manager or HR contact. They are intermediaries between workers and leadership and need to have the independence to command the trust of both. They thank workers, escalate concerns and ensure that appropriate action is taken, then provide feedback on outcomes. Feedback is an important aspect of the Guardian role as a lack of feedback creates apathy in the process and can contribute to the cultural perception that speaking up is pointless, because nothing will be done. Guardians support leaders to listen and act and report on themes to their boards and leaders.
We know that the hierarchical nature of NHS culture can be a challenge, so Guardians have been recruited from different staff groups (nurses, chaplains, therapists, managers, and doctors) and a range of seniority to offer different perspectives. Many organisations have networks of Freedom to Speak Up Champions, drawn from a broader cross section of the workforce. The network has now grown to over 500, with many more in supportive speaking up roles such as champions and ambassadors. More than 19,000 cases have been brought to Guardians in trusts over the first two years of collecting data, and the number of cases continues to rise.
The National Guardian’s Office supports the network through training, guidance, the dissemination of good practice, the undertaking of case reviews, and the provision of support and challenges. Any speaking up matter can be brought to a Guardian: a safeguarding concern, a patient safety issue, concerns around bullying and harassment and also suggestions for improvement. Guardians will either confidentially escalate to the appropriate person in the organisation or support the worker to speak up themselves.
Many organisations outside of the health sector are seeing the benefits of the Guardian model and we are now seeing it replicated in various sectors. As we see the Freedom to Speak Up movement grow, we are welcoming Guardians from other organisations such as primary care, private healthcare, regulators, national bodies and universities. You can find out more about the Freedom to Speak Up Guardians where your students are on clinical placement. If you would like to establish a Guardian role in your faculty or university, please visit our website, where you can find the universal job description.
Speaking up can take courage. We know that students and trainees feel especially vulnerable and fearful of perceived detriment before their careers even begin. At the same time, they are the personification of ‘a fresh pair of eyes’ and may see things in a way others don’t. Universities can support their students by modelling the behaviour we want to see in healthcare settings as they educate future workers. Making speaking up business as usual requires a culture change, not just in health, but throughout our workplaces.
To truly embed a Freedom to Speak Up culture throughout health and beyond, we need to start with universities. If it is the role of universities and Deans to nurture the next generation of leaders, then you also have a role to play in establishing a listening environment which encourages a diversity of voices. By modelling this behaviour, you will also help students develop their own abilities to speak up when it is needed.
Speaking up has the potential to improve every organisation that embeds the principles to make it work and in doing so, enter a process of continual learning, enhancement of the working environment and the staff experience and, ultimately, the efficiency of the organisation. In healthcare, that has the potential to save lives, improve patient experience and the working lives of our colleagues.