FTSU case story: Helping staff feel safe to speak up

Principle 3: Communicating about speaking up

Summary

The NHS England Freedom To Speak Up (FTSU) guide for leaders discusses eight principles fundamental to creating environments in which people feel safe to speak up with confidence.

The case story below gives an example of how these principles have been used to cultivate and demonstrate evidence-based improvements in NHS organisations.

NHS leaders (including executive and non-executive FTSU leads) and FTSU guardians can take inspiration from these case stories and use them to help develop their own plans for improvement to ensure that they develop healthy speak up cultures.

What was the problem?

The NHS organisation received around 30 speaking up concerns in 2019/2020. Suspecting this did not reflect a true picture of all staff concerns, the organisation sought to review its processes, expecting these numbers to increase.

At that time, a single FTSU guardian was in place who could dedicate one day a week to the role, and a small team of champions located across the organisation’s 10 sites.

In early 2020, a pulse survey showed staff were concerned about how securely the information they shared was kept. A review of the organisation’s FTSU arrangements, using the review tool created by NHS England, revealed some gaps in their arrangements in relation to the use of champions.

What was the solution?

To raise awareness of the FTSU guardian and build trust in their ability to keep information secure and confidential, the organisation did the following:

  • Recruit a diverse group of speak up champions

The group was promoted on a dedicated intranet page, alongside photographs, biographies and videos to help staff feel that champions were more relatable and approachable, and to find out more about speaking up.

  • Create a case management system

This allowed speaking up documentation to be stored securely and thematic data reports to be created for the provider’s executive team, the board and the National Guardian’s Office.

A case information access policy was created, detailing circumstances in which someone other than the guardian and relevant case manager could look into the cases. The security and confidentiality of the case management system was a key part of the publicity drive.

  • Issue a wide range of communications

The diversity of the FTSU champions and the security of the system were the focus of communications. These went out in several formats, such as screen savers, posters, corporate and directorate e-newsletters and personal presentations by the champions themselves.

What were the challenges? How were they overcome?

  • It is hard to get regular space in corporate communications channel

Corporate communications can be useful, but it was the bespoke communications done by the guardian and champions that really built trust and confidence.

Often this communication took place with staff networks in their meeting spaces. Corporate communications should act as a steady reminder, but the trust-building work has to be done at the most direct level possible.

  • People feel anxious about publishing speaking up stories

The organisation felt speaking up stories could dispel the fear that speaking up to a FTSU guardian was stressful and difficult.

While some people who had spoken up were happy to tell a story and have it published on the intranet, they invariably did not want to be named; therefore, stories were anonymised. The impact of the stories was measured using ‘page view’ and ‘click through’ data.

  • Creating a case management system that protects identity and enables visibility of data is tricky

Serious consideration should be given to balancing the level of detail that the executive team want while protecting names and any means of identifying respondents.

What were the results?

The number of people speaking up has risen year-on-year: an 80% increase in 2020/21 (from 30 cases up to 54); then a further 181% increase in 2021/22 (152 cases).

There is no rule of thumb in relation to the amount of speaking versus the number of people in the organisation. Speaking up volume, themes, trends should always be triangulated with other data.

However, to date, on average, two thirds of the people who speak up are willing to be named, which indicates a degree of trust and confidence.

What are the next steps?

Reduce the number of anonymous reporters. Anonymity makes it impossible to signpost to health and wellbeing support, or to feed back on what has been achieved with the information provided. Therefore, the organisation will continue to think about how to build trust and confidence.

Current steps include:

  • improving information on the intranet about how the guardian looks after the information people share
  • encouraging people to simply meet the guardian, to find out who they are and how the process works.

What advice would you give to someone thinking of introducing something similar?

Change takes time; reducing hesitancy (to bring about behavioural change) can take several years. It’s important to manage expectations around the measuring of improvement.

As noted, bespoke communications via the guardian and champions are most effective at improving trust and confidence. Corporate communications can act as a steady reminder, but the trust-building work has to be done at the most direct level possible.

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