Principle 5: Learning from 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?
In 2019, this NHS organisation had high numbers of people speaking up when benchmarked against similar types and sizes of trusts. At that time, it had one full-time FTSU guardian.
The most cited reason for using the guardian in 2019 was a poor response from line managers when staff tried to speak up to them (83%).
What was the solution?
The FTSU executive lead and the guardian needed to further support managers in understanding their responsibilities when staff spoke up; and to be aware of how to deliver a psychologically safe workplace.
What was the method?
- Training for managers
The trust used the National Guardian Office’s (NGO) online training for managers’ FTSU – elearning for healthcare (e-lfh.org.uk).
Taking approximately 30 minutes, they made it ‘essential to role’, to be completed every three years for anyone in a management position. They also made it an open course so those who wanted to progress to a manager role could complete it voluntarily.
The aim was 80% compliance. Where the training had not been completed, a reminder email was sent from the Learning team with the guardian’s details attached and offered a conversation to understand barriers to completing the training.
- Managers’ toolkit
The guardian worked with the Organisational Development team and HR department to develop guidelines for managers when responding to speaking up.
The toolkit had a foreword from the chief executive officer highlighting their support and included guidance on confidentiality, how to feedback, how to share learning, and a section on how to create a psychologically safe team and manage unwanted behaviours.
This was published on the intranet and sent to every manager when they were asked to investigate a speak up issue by the guardian. This meant that when people spoke up to them, they knew where and how to access the information.
- Communications plan
A plan was developed with the communications team that targeted groups and events for managers. Information was shared via the trust’s social media channel, their internal senior leadership forum, and the chief executive briefings.
The guardian also arranged bespoke training sessions for managers and visited teams to talk about the training and toolkit.
What challenges were there? How were they overcome?
It is hard to get regular space in corporate communication channels.
Using the same repeated message to staff about the training took little time for the corporate communication team to produce and helped to keep awareness among staff high. It was also included occasionally as a line or short paragraph in the chief executive’s blog and the trust managers’ communications.
The guardian and champions could do more localised, informal communications, targeting areas where training uptake remained low.
What were the results?
The reminder email about the training sent from the learning team to staff increased uptake from 57% to 78%. This is high for ‘essential to role’ training in its first year. In the second year, with increased communications over the previous 12 months, the trust exceeded 80% uptake.
To measure the success of the intervention the reasons for staff approaching the guardian to speak up were analysed by the organisation again.
This analysis showed that the guardian now received fewer simple queries and, while some who spoke up to the guardian still cited their manager’s poor response as a reason for doing so, this did decrease after the intervention:
- 2019- 2020: 83%
- 2020-2021 (during the 12-month intervention): 69%
- 2021-2022: 67%
What are the next steps?
- Update the toolkit with new NHS England/NGO’s guidance.
- Communicate the update in managers’ briefings and on the intranet.
- Continue to address the reasons for non-completion of training.
- Assess whether incoming cases correlate with areas of low/high uptake of the training.
What advice you would give to someone thinking of introducing something similar?
Don’t be afraid to ask for speak up training to be ‘essential to role’ for managers. While they have many competing priorities, the NGO training is only 30 minutes and the benefits are worth it.
Find out more
- NHS FTSU Guide – Principle 5 – Learning from Speaking up p.18
- For further information, please contact england.ftsu-enquiries@nhs.net.