Developing compassionate ‘speak up’ cultures – within a Trust and across the region 

Judith Graham, Deputy Director for Organisational Learning & FTSU Guardian, Rotherham, Doncaster and South Humber NHS Foundation Trust

This year’s winners of the HSJ Award Freedom to Speak Up Organisation of the Year, Rotherham, Doncaster and South Humber NHS Foundation Trust, have approached the adoption of Freedom to Speak Up in a holistic way, focussing on inclusivity and developing both their own organisational culture and that of other organisations in their area.

“We had an ambition to develop our local culture in parallel with the development of joint-work with our regional partners,” said Dr Jude Graham, Deputy Director for Organisational Learning and Freedom to Speak Up Guardian of the trust. “This, we believe, supports patient safety and staff wellbeing in a ‘place-based’ and integrated way.”

Making a conscious decision to work beyond the organisational boundaries has enabled others to develop more positive speak up cultures, which is beneficial for patients accessing the whole health system in their area.

The trust has worked with neighbouring providers who may have ‘requires improvement’ or ‘inadequate’ CQC ratings and have different challenges. By connecting with other trust leads about Freedom to Speak Up, RDaSH has been able to share processes and spread good practice.

“It has also helped to establish systems to communicate and collectively address issues that have occurred in co-located departments,” said Jude. “Speaking up is at the heart of “the RDaSH way” – the belief that to make changes that improve the quality of services, the Trust needed to focus on culture and “the way we do things across our organisation’.”

At the centre of the RDaSH approach is a passion for inclusivity and diversity, with a sensitivity to the needs of more vulnerable workers, who may find speaking up even more of a challenge.

The Cultural Improvement and Development Team, led by Jude, supports the collective function of Freedom to Speak Up; Equality, Diversity and Inclusion; Quality Improvement; and Learning and Development. “This targeted integration enables a wider spread of Freedom to Speak Up, but also joint-working that supports our most vulnerable staff and patients,” said Jude.

Some of the ways in which RDaSH has embedded a speak up culture include:

Developing deliberately diverse FTSU advocate roles to increase accessibility with a mixture of skills, roles, seniority and geographical locality. Advocates receive training and bi-monthly supervision.

Establishing BAME, LGBT+, Disability and Faith diversity networks, empowering people who may feel unable to speak up and involving workers to make meaningful change after concerns have been raised.

Ensuring that all new starters receive FTSU information at an induction session, led by the CEO, with additional targeted induction sessions led by the Deputy Guardian for staff groups who may be more vulnerable (i.e. junior doctors, student nurses, bank workers and volunteers).

Introducing digital ways to speak up, including an anonymous ‘speak up button’ on the trust website, and Improvement-Hub ‘speak up’ challenges. These are in addition to existing ways workers can speak up: via phone, text, email, face-to-face meetings and social media.

Freedom to Speak Up is linked with other core businesses within the trust. For example, Speak Up training was provided to over 200 clinical workers, demonstrating how speaking up is an essential safeguarding measure. Another example is World Mental Health Day, when Freedom to Speak Up is linked to workplace well-being.

The Trust has a collective approach to Freedom to Speak Up. The focus is on easy access, early detection and consistency, involving line managers and clinical leads, but also alternative routes like guardians, the learning team, staff-side representatives, the safeguarding team, the spiritual care team, well-being support and the health and safety teams.

“We’ve learned from experiences both at RDaSH and other trusts that if Freedom to Speak Up roles are isolated, or have insufficient time allocated or an inadequate infrastructure around them, then that creates barriers to speaking up,” said Jude.

Workers who have spoken up become ambassadors, spreading the message that value can be gained from raising issues. They are offered the opportunity to become a member of ‘ICAN’. “I-CAN stands for ‘Improvement Culture Ambassadors Network’ and focusses on what people can do to help support improvement,” said Jude.

“We gather feedback from all workers who have spoken up and use the statistical and narrative feedback in our review of FTSU processes, as well as in promotional material to encourage others to ‘speak up’.”

Our focus on FTSU and improving organisational culture has yielded positive outcomes in terms of our patient care, staff feedback and has contributed to our CQC rating moving from ‘Requires Improvement’ to ‘Good’, of which we are proud,” said Jude.

“This broader approach to FTSU has both improved our patient safety culture and enabled systemic improvements across organisational boundaries. This type of joint working is essential to meet the vision of the National Guardian and the NHS 10 Year plan,” she concluded.

November 28, 2019