Dr Henrietta Hughes on making the fear of retribution a thing of the past and speaking up business as usual in the NHS
Speaking up saves lives. In every workplace, embedding an open culture is vital to allow workers to voice their concerns. In healthcare, when we fail to listen to people, it can compromise patient and worker safety.
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Freedom to Speak Up is growing as a social movement. There is an appetite to drive out archaic attitudes which favour compliance over dialogue. It is the role of leaders to foster this culture, ensuring that when people speak up, they listen up and follow up. The challenge is to make the space to listen through the pressure.
The global pandemic has shown that Freedom to Speak Up has never been more important. “Voice” is one of the NHS People Plan’s core pillars and why this is a critical part of workplace culture is twofold. Firstly, it is about unearthing matters before they become major problems. But also, worker experience is vital for delivering compassionate care; a happy workplace retains its employees and is a great place to work, which is another of the ambitions of the NHS People Plan.
With nearly 600 Freedom to Speak up Guardians in England, the network initially covered NHS trusts but has since expanded into primary care and beyond. Numerous national bodies and independent providers have appointed guardians to advance their own speak up cultures.
Over the last three years guardians have handled over 35,000 cases brought to them by NHS workers. The information that each of these cases provides to an organisation is a gift – an opportunity to learn, to change, to improve.
The importance of speaking up when something is wrong in healthcare is potentially the difference between life and death. Workers must feel they are able to raise concerns in a transparent culture, without fear of retribution, to identify and resolve any issue in its infancy. We have seen shocking examples during covid-19 where people have tried to voice their concerns and yet have faced victimisation and intimidation.
Freedom to Speak Up guardians have played a vital role during the covid-19 pandemic as an alternative channel where people can speak up safely. At the height of the first wave, our pulse surveys indicated that guardians were receiving speak up cases related to PPE, social distancing, fit tests and risk assessments for BAME colleagues.
The survey was first conducted in April, repeated in May and then again in June. Over that period my office tracked a definite change in attitude and perception. In April only 72 per cent of guardians who responded to the survey believed that workers continued to be encouraged to speak up. By June that had risen to 93 per cent.
As we prepare for a potential “second wave” of covid-19, Freedom to Speak Up is more important than ever. Many guardians are meeting and listening to workers as part of reset conversations, checking on wellbeing and enabling productive solutions to be found. Guardians meet regularly in regional networks to share ideas, buddy and support one another. Your guardians can support your workers, working in partnership with other parts of the organisation to identify areas of concern and escalate swiftly.
When our colleagues speak up, we need to be there to listen up, follow up and keep people safe so that fear of retribution becomes a thing of the past and speaking up is business as usual in the NHS.
