Service user safety and ensuring that staff feel supported and happy at work is everyone’s responsibility. We all have to be accountable for speaking up if we think someone isn’t OK or we’re worried about something in the workplace.
But what happens when any one of us – be it a healthcare assistant, a nurse, cleaner, doctor or administrator – is worried at work? What if we don’t feel able to raise our concern with a line manager? How do we develop a culture where safety concerns can be identified and addressed at an early stage?
These questions are as important for the health care organisations that people work for as they are for the employees within them.
To truly improve safety and make the health sector a better place to work, the National Guardians Office says that organisations need to place less emphasis on blame when things go wrong and more importance on transparency, learning from mistakes and recognising opportunities for improvement.
As Cygnet Health Care’s newly appointed Freedom to Speak Up Guardian, Julie Garbett is key to encouraging a culture where speaking up is celebrated and where staff feel empowered and able to raise concerns. Here she explains who can speak up and why it’s so important.
“As a registered mental health nurse for over 20 years, I have worked in some amazing teams where speaking up was encouraged and welcomed, and I have also worked in environments where if you spoke up you were maybe seen as a trouble maker and concerns were ignored. I have learned that even in the best-run organisations, raising and responding to concerns can be a real challenge.
“I want Cygnet to be a provider where speaking up is the norm, and it’s encouraged, a place where people feel valued and fully supported when raising concerns about patient safety or about ways of working or things they think could be done a little bit better.
“Speaking up can take many forms. At Cygnet, there are already many channels for speaking up – from a discussion with a line manager to submitting suggestions for improvements. My role within the organisation is to give staff an extra level of support if they are worried, unsure, concerned or feel they can’t talk to someone within their line management or in their team. The board recognises and is fully supportive of this. By speaking up, the hope is that anything that is getting in the way of high-quality effective care, or that affects their working life, can be identified early and that potential harm is prevented.
“The Freedom to Speak Up (FTSU) concept was introduced by Sir Robert Francis following a 2015 review into ‘whistleblowing’ processes within the NHS. There are three elements: improving and protecting patient safety; improving and supporting staff experience; and visually leading and promoting learning cultures that embrace continual improvement.
“Looking at the national statistics published by the National Guardians Office (NGO), which collects data from guardians on a quarterly basis, it’s clear why this policy is so important. Of 4,120 cases raised to FTSU guardians in NHS Trusts and Foundation Trusts between October – December 2019, 915 included an element of patient safety/quality of care and 1,496 included elements of bullying and harassment. Around 147 related to incidents where the person speaking up may have suffered some form of detriment.
“The recent Covid-19 crisis has also underpinned how important it is for valued health and care workers to be listened to and responded to, with the NGO reporting that workers nationally are speaking up about worker safety and wellbeing, and that there has been a spike in the number of workers reporting behavioural issues, such as bullying. The impact of COVID-19 on Black, Asian and Minority Ethnic (BAME) colleagues has also been widely reported in the media, and reinforced the value of staff having access to safe channels to speak up.
“The responsibility for making sure healthcare organisations deliver high quality safe care rests with us all. From the statistics, the people speaking up include nurses, administrative and clerical staff, healthcare assistants, cleaners and doctors. I can see that from the people at Cygnet I’ve met so far, they all see the value in fostering this positive type of culture. The challenge is making sure that speaking up becomes the norm everywhere.
“To fulfil my role, I need to remain impartial and independent. Although I report to David Wilmott, Director of Nursing, I sit outside of the usual organisational structures. I do not carry out investigations, but I help people to have a voice and work alongside the service and the person raising the concern to address it. I can also escalate concerns to the Cygnet Board and externally if needed, but my hope would always be to address issues before we need to get that far.
“Individuals or teams can raise issues anonymously via telephone call to me, or via email. Ideally it would be great if they could put a name to the concern so I can make sure they get feedback about actions and investigate it fully. It sometimes makes it a little harder when it’s anonymous, but I also understand why people feel unsure about speaking out and I will always try to take forward anonymous issues if we have enough information to do so.
“I am also setting up a group of Freedom to Speak Up Ambassadors, so that there are lots of local faces people might contact or speak to for advice and where we can develop a network to provide support.
“I have been made to feel really welcome at Cygnet. It’s a big change for me, but I come with an open mind and I think that will help in this role. The one thing I would say, is if you are unsure or worried and you feel that you can’t talk to somebody in your team, speak up.”
About the author
Julie is a registered mental health nurse of 20 years, with a vast range of experience gained working for NHS Mental Health Trusts and CMHTS in the South East. Julie can be contacted at [email protected].
For further information on the National Guardians Office and the FTSU concept, go to: https://www.nationalguardian.org.uk/.