Embedding Speaking Up Through Worker Engagement

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Northamptonshire Healthcare NHS Foundation Trust

Northamptonshire Healthcare NHS Foundation Trust were highly commended in this year’s HSJ Freedom to Speak Up Organisation of the Year Award.

Evidence shows that where workers feel care and safety are priorities for their organisation, patient outcomes are enhanced. Northamptonshire Healthcare NHS Foundation Trust’s engagement approach, Let’s Talk, focuses on the power and value of communicating and engaging with workers so they can feel confident in speaking up and that they will be listened to. It highlights how all workers can make a difference and work together to deliver outstanding care for and with service users, with the aim of making NHFT a great place to work and receive care.

In order for workers to have the confidence to speak up, they need to feel psychologically safe and supported, particularly if they are from a vulnerable or minority group. The majority of NHFT’s 24 Freedom to Speak Up champions are in place to support vulnerable workers groups including people in staff networks (Black, minority and ethnic (BME) colleagues, those with disabilities, working carers and LGBTQ+), junior doctors, apprentices and non-qualified workers.

An example of the change which can result from these champions is that of a BME worker who spoke up to a champion about perception of bullying from managers and pressure on workers in one of the Trust’s services. When the worker shared with colleagues that they had met with the champion and the guardian, a further 10 team members spoke up about their experiences.

As a result a full “speaking up inquiry” was completed and provided the opportunity for other workers to speak up about their experiences. The Trust found that resources had stayed the same but referrals had doubled. Problems were hidden because workers were doing the best they could, but the pressure to achieve targets in this service was affecting behaviours between managers and colleagues.

By triangulating information from other data sources including Datix, Serious Incidents and other speak up reports, this has resulted in a complete review of the service pathways including workers, service users and partners including GPs and third sector partners. Referrals, including self-referrals, now call a single number which is staffed by trained third sector administrators who sign-post patients to the right service or refer to appropriate practitioners, thus relieving some of the pressure on workers and improving team culture.

In the 12 months since having a BME champion, there was a 300% increase in concerns from BME colleagues. The latest Staff Survey results have showed a 3% increase in BME workers feeling secure in speaking up about unsafe clinical practice; a higher increase than the result for white colleagues.

It is recognised that cultural change is inspired by senior leaders and boards are vital in inspiring collective leadership. NHFT has embedded internal “case reviews” for concerns raised with the guardian. The process is overseen and reported to a Trust-level committee to quality-assure the process followed and identify learning to be shared. The most recent review identified improvements NHFT should make for workers interviewed as witnesses in HR processes and a review of appraisal processes for medics.

An example of significant change as a result of Freedom to Speak Up is the structural change in the Trust’s Adult and Children’s Directorate to establish increased clinical leadership of services. Several significant concerns highlighted a lack of clinical involvement in clinical decision-making, leaving workers worrying about safety of services. The new model includes a clinical director in all directorate areas, working alongside an assistant director to ensure that operational decisions are made with senior clinical input to ensure the safety of our service users.

Since the Freedom to Speak Up programme was introduced, NHFT has seen a 15% increase in recommendation as a place to work and an 11% increased recommendation as a place to receive care. Increased numbers of workers speaking up to the guardian have been reported for ten consecutive quarters.

High reporting rates of errors and near-misses is strongly linked to improved safety culture and NHFT has worked hard to encourage reporting of errors and near-misses to enable learning to take place. NHFT has seen a 20% increase in Datix reporting over the last three years, with outcomes of no harm/near- miss increasing and moderate/severe harm decreasing. This demonstrates that learning is taking place from near-misses/low harm incidents and workers report feeling those involved in errors are treated fairly, up 12% from 2016.

The National Staff Survey 2018 results show increasing confidence in speaking up, with a 7% increase in feeling secure in raising concerns about unsafe clinical practice since 2015 and an 11% increase in workers feeling confident their concern would be addressed.

In 2018, NHFT achieved ‘Outstanding’ CQC status, including ‘Outstanding’ for the ‘Well-led’ domain. The report stated that an “open and transparent culture was fully embedded.”

January 9, 2020