PATIENT SAFETY
to the mechanisms in place for the culture change which is required.
The guidance requires that there are strategies in place and that the Trust can provide evidence of a leadership strategy and development programme that emphasises the importance of learning from issues raised by people who speak up. The strategy should reflect realistic and robust actions which link with patient safety, staff experience and continuous improvement. It identifies that there should be an up to date Speaking up policy that reflects minimum standards set out by NHS Improvement.
The process for development of the local policy has been devised with the local Speaking up Guardian and a range of other stakeholders and is aligned with policy and guidance from the National Guardian. Progress is regularly reviewed at board level using a range of qualitative and quantitative measures. The Care Quality Commission measure progress against the development, as part of its’ well led domain. The Kings Fund7
high quality performance
l Behaviours characterised by support, compassions and inclusion for all patients and staff
l Ways of working that focus on continuous learning, quality improvement and innovation
l Enthusiastic co-operation, teamworking and support within and across boundaries.
writing about the values
and behaviours of the best performing trusts in the country cite a number of specifics which need to be in place if the leadership of the different trusts in NHS are to deliver high quality, continually improving and compassionate care. They are: l An unwavering commitment to providing safe high-quality care
l A commitment to effective , efficient,
The leadership values which they identify as a significant part of a nurturing culture which would support the above approach to leading an NHS trust and need to be continually reinforced are developing and empowering people, encouraging shared learning and continuous improvement, building trust and co-operation, supporting inclusive climates and managing performance. The author would like to add a further element which is a listening and learning culture. So many professionals who have whistle blown in the past been ignored for a long time before an incident occurs, the organisation was not listening. Kings Fund suggests that the command and control means of management in the NHS is the dominant leadership style and it needs to move towards a more inclusive and collective model. Collective leadership is where staff at all levels act to improve care- within and across organisations. It means ‘leadership of all, by all and for all’ Leaders in a culture where Freedom to is promoted are proactive in
Speak Up8
developing a culture where ideas can be expressed and initiatives are made to support speaking up. Senior leaders are visible in the organisation, approachable and use a variety of methods to seek and act on feedback from the workforce. Senior Leaders prioritise speaking up and model their behaviour by acknowledging mistakes and making improvements. This means that the board can state with confidence that the workers know how to speak up, do so with confidence and are treated fairly.
It is essential that the Freedom to Speak up Guardian in the Trust has ready access to senior leaders whether they are the designated directors or the chief executive, for support as required. It also means regular opportunity for escalation of events, particularly if they are patient safety issues. It needs to be demonstrated that priority is given to acting on patient safety concerns and any evidence that workers have been victimised as a result of speaking up – however senior they are. Data from the Guardian’s Office9
shows
that in the last 12 months: l 8882 cases have been raised to Freedom to Speak Up Guardians (1625 anonymously)
l 2805 cases include an element of patient safety/quality of care
l 4096 included elements of bullying and harassment
l 449 related to incidents where the person speaking up may have suffered some form of detriment.
SEPTEMBER 2018
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