NHS National guardian Henrietta Hughes introduces a new e-learning package, and explains how line managers can foster a listening culture that supports staff who want to speak up.

COVID-19 has had an impact on everybody’s life. As a GP, I have seen its effects on my patients and their families, as well as on my colleagues. COVID-19 is having long-term effects personally and professionally on all of us in the NHS. I am humbled and inspired by the incredible NHS workers and those who support them to deliver excellent care in extreme circumstances. Speaking up is now more important than ever, and a ‘speak up, listen up, follow up’ culture supports the four pillars of staff engagement: strategic vision, engaged managers, worker voice and integrity.

As the national guardian for the NHS, I lead a network of Freedom to Speak Up Guardians in England that aims to ensure people can speak up about anything which gets in the way of delivering great care. The National Guardian’s Office provides training, support, insights and learning to the system. 

Our public directory includes guardians from trusts, primary care, hospices, the private sector, and national bodies, such as the CQC and NHS England/Improvement. There are now more than 600 guardians in over 400 organisations. Freedom to Speak Up Guardians support workers to speak up when they feel unable to do so by other means and escalate issues so that the right actions are taken. Guardians handled over 16,000 cases in 2019-20 of which 36 per cent involved an element of bullying and harassment. As well as supporting workers to speak up, guardians also have a proactive role, working in partnership to identify hotspots of poor workplace culture and tackle barriers to speaking up.

Listening is everyone’s business

There are many barriers which can silence people, such as hierarchy and conflict of interest. If people fear losing their jobs or being victimised or bullied, they may stay quiet when they see issues that need addressing, and things that could have been resolved at an early stage could potentially lead to harm. Listening to workers is everyone’s business – it helps to reduce risk, prevent harm and make improvements – and also helps people to feel valued and supported at work. 

Managers play a key role in fostering a culture where speaking up is encouraged and valued. But, without support, managers may feel vulnerable when people do speak up, particularly if the issue is personal or the feel it undermines their role. It can be difficult to remain curious and open to learning in this situation. Managers at all levels need support and training in listening without judgement and using the information for learning and improvement so that they remain engaged and ready to lead and support their teams. 

We have recently launched a new e-learning package, in association with Health Education England. The first module, ’Speak Up’, is for all workers, was launched in October and has already been completed by 800 people. The latest session, ‘Listen Up’, is for managers, and focuses on listening and understanding the barriers to speaking up. A final module, ‘Follow Up’, for senior leaders, will be launched later in the year to support the development of Freedom to Speak Up as part of the strategic vision for organisations and health and care systems.

Influence of line managers 

Although tone from the top is important and sends a message throughout the organisation about what behaviours are expected, it is the line manager who has the strongest influence on workers’ psychological and physical environment. 

As line managers, you may often be the first port of call for people with concerns. In this way, you have a central role in fostering a workplace culture where Freedom to Speak Up is encouraged and supported, where speaking up, listening up and following up are part of everyday life. When you role-model equality, civility and respect, this has an impact on your organisation’s culture. People look to you for leadership and your behaviours will be adopted by your team.

This e-learning will help you develop positive leadership behaviours to foster a ‘speak up, listen up’ culture. It will develop understanding of what barriers exist to speaking up and how to support workers when they do.

It takes courage to listen

It takes courage to speak up, but it also takes courage to listen up and follow up. This is where your personal integrity as a manager comes into play. The pandemic has highlighted the impact on patients, workers, organisations and society when people repeatedly speak up and don’t feel heard. 

A supportive Speak Up culture is one where all of us should be able to speak up about anything, knowing that it will be well-received and that the right actions will be taken as a result. Where we can share ideas, seek advice, offer feedback, challenge decisions or speak up without fear of repercussions. Sign up for the training and share your pledge as you play your part to make Freedom to Speak Up business as usual.

• Dr Henrietta Hughes OBE FRCGP is the National Freedom to Speak Up Guardian and a GP working in central London. MiP published its guide to organisational culture, Creating a healthy workplace, in April 2021. Find out more and download your copy here.