Creating a Speaking Up Culture Across a Merged Organisation

University Hospitals of Derby and Burton NHS Foundation Trust

University Hospitals of Derby and Burton NHS Foundation Trust were finalists in 2019’s HSJ Freedom to Speak Up Organisation of the Year award.

Mergers can often leave workers feeling anxious and uncertain. When the hospitals in Derby and Burton merged, workers were unsure whether they would still have access to the Senior Leadership team to flag any concerns. With the help of the Freedom to Speak Up Guardian, Alison Bell, University Hospitals of Derby and Burton NHS Foundation Trust (UHDB) now facilitates an event which encourages an open speaking up culture across the merged organisation.

UHDB was created in July 2018 and it has five sites located in Derbyshire and East Staffordshire. The trust has over 12,500 workers across community hospitals, district general hospitals and large acute teaching hospitals. UHDB workers have a wide range of needs and cover various locations so it is a challenge for the Freedom to Speak Up and Senior Leadership teams to cover all bases.

In preparation for the move, the Executive teams appointed Alison as the Freedom to Speak Up Guardian for separate trusts in both Derby and Burton 18 months prior to the merger. This allowed Alison to begin to create a speak up culture before the move so that workers from both trusts were familiar and comfortable with the process.

Alison Bell, Freedom to Speak Up Guardian, University Hospitals of Derby and Burton

Following the merger, the Executive team introduced themselves during roadshows at all five sites. However, due to the busy workload post-merger, many UHDB workers felt they did not see the Senior Leadership team enough.

Eager to ensure the two-way communication process between UHDB workers and the Executive team remained accessible, Alison discussed ways of improving the leadership’s visibility. She said, “Workers were feeling anxious that they were unable to speak to the Senior Leadership team about their concerns and to ask questions about what was planned. Having been used to the senior leadership being very visible and responsive, they were worried that they would be unable to access them if they needed to raise clinical issues quickly.”

Alison liaised with Sir Stephen Moss, Non-Executive Director and former turnaround Chair at Mid-Staffordshire, who has a passionate interest in speaking up. They arranged to hold regular ‘Speak Up Surgeries’ on all sites to provide confidential drop-in sessions for UHDB workers. An example of this was when a therapy assistant approached Alison with a concern about the trust’s discharge process for alcohol and drug users. There were several cases of repeat admissions because alcohol and drug users were discharged into unsuitable environments. The therapy assistant visited a Speak Up Surgery session after their concerns were not acted upon by the manager.

After the surgery, Alison contacted Sir Stephen Moss and the Director of Nursing to remedy this issue. Several measures, such as team training and Organisational Development involvement, were put in place. As a result of the Speak Up Surgery, there have been fewer repeat hospital readmissions for drug and alcohol users. This protects patient safety and vindicates the therapy assistant’s decision to speak up.

Another request often made during Speak Up Surgeries, and via email to Alison, was to have more input into trust decisions. UHDB set up an online listening platform and also arranged some listening events at all sites. This platform, alongside divisional away days, gave thousands of UHDB workers the opportunity to voice any concerns to the Senior Leadership team – either anonymously online or in-person. The staff also co-created the new trust values, behaviours and mission statement, meaning the UHDB values have been built from the ground up.

The communications team also set up ‘Time for Tea’; an informal event at all sites attended by UHDB workers, members of the Executive team, Senior Leadership team and the Freedom to Speak Up Guardian. Over breakfast, cake or a cup of tea, workers were able to raise any concerns with senior figures or Alison. Ten events took place across five sites and over 400 people attended. Owing to the popularity of ‘Time for Tea’, evidenced by increasing attendance and positive feedback, the trust has now decided to make this a bi-monthly event.

Alison said: “A recent comment from a worker at a community campus was that other workers who attend the events have said they feel safe to speak up directly to the Board members when they attend. This is encouraging others to speak up within their teams.

“The most compelling outcome has been that the Board have seen the positive impact on workers by being on site and available in an informal setting,” Alison added. “Senior leaders now have a presence on all sites more often. This has allowed them the opportunity to respond quickly and face-to-face with workers speaking up. The CEO has spoken about how much he has learned about some of the challenges a range of workers are facing from attending the sessions. He sees them now as a valuable part of staff engagement.”

UHDB’s Freedom to Speak Up message is supported by the Executive team with the new Non-executive Director for speaking up, Joy Street, chairing the Board’s People Committee and the CEO has encouraged speaking up during a weekly blog. It is also made a part of the culture at UHDB through the induction process, the intranet page and the 22 Freedom to Speak Up champions. With a variety of pathways for those wishing to speak up, and 99 per cent positive feedback from workers, UHDB’s Freedom to Speak Up Guardian and Senior Leadership team are providing workers with the tools to adapt to the merger.

January 22, 2020