Focus on raising concerns and the liaison service

As part of their workshop sessions on promoting professionalism, our liaison service runs workshops to help doctors feel confident speaking up. Between January 2017 and September 2018, the liaison service delivered 515 workshops, attended by almost 11,000 doctors across England, Northern Ireland, Scotland and Wales. 

Doctors who attend our workshops are clear that they wouldn’t hesitate to raise a concern when immediate patient safety is at stake. But they face a number of barriers which can make this difficult.

In workshops across the UK, the main challenges relate to understanding the reporting routes and complications with the systems for raising a concern. In England, doctors were often not aware of the existence of, or contact information for their freedom to speak up guardian. And, due to trainees and locum doctors moving around different locations, many in these groups reported that they found it hard to familiarise themselves with each hospital or practice’s procedures. To tackle this, our workshops try to introduce doctors to support available at their workplace, by making connections to the freedom to speak up guardians and other local systems in the four countries. Doctors also mentioned that the ‘feeling that nothing will change’ or that they will receive no response discourages them further in finding out the routes at a new location.

Doctors also spoke about the fear of blame if they raised a concern about a colleague or organisation. Their feedback often referred to doctors worrying that they will be perceived as 'trouble makers' and the impact that raising concerns can have on their professional relationships and career. And some fear that if they raised a concern about the pressures of resources and workload they would be labelled ‘weak’ or their own efficiency would be questioned. 
Doctors in training in particular felt that they might leave a negative impression on senior staff if they raised a concern with them. These discussions were often related to issues around organisational culture and its impact on confidence to speak up.

What’s positive to see is that trainees who attended the workshops felt they better understood the importance of speaking up and how we can help, for example with our confidential helpline or our guidance. Doctors in training told us the workshops helped them to realise that even concerns that don’t seem to obviously relate to patient safety can be and must be raised.

We encourage doctors to use the national training surveys to highlight any issues around speaking up they may have. We take great care to make sure that the information we receive in the survey is confidential, and we will emphasise and explain the steps we take to do this in next years’ survey.