Speaking up - a Freedom to Speak Up Guardian's experience

We asked renal consultant Dr Tina Chrysochou to tell us about her experiences acting as lead Freedom to Speak Up Guardian (FTSUG) at Salford Royal NHS Foundation Trust since 2016.

Tell us about your role and how this works at your trust.

In one sentence, the Freedom to Speak Up (FTSU) team acts as a safety valve in the organisation. I work with a team of guardians, and our remit is to take on cases where patient safety concerns have been identified and not satisfactorily resolved. We retain impartiality by being independent of divisional structures and not directly investigating concerns which enables us to hold investigators to account. This also keeps the workload manageable. We access and escalate to the most senior level. I coined the phrase a 'peer with an ear' to describe the FTSU service as we aim to empower individuals using the service.

As a doctor, what have you learned by doing this role?

It is dedicated, hard-working people who make the NHS what it is. But I've learned that even in the best run organisations, raising and responding to concerns can be challenging. However, we're all on the same side and have a duty to do so, to protect patients. Speaking up is relational. Concerns raised about patient care provide vital intel to an organisation and this information should be welcomed. The process is incredibly rewarding for all involved when done well.

I have also learned that there may be two or many sides to a story, so it is crucial to remain impartial and collect the facts.

Importantly, it is always best to raise concerns at an early stage to 'nip any issues in the bud' before they escalate and affect inter-personal relationships and patient care.;

What changes have you seen in your trust as a result of speaking up?

In general, there is more awareness on how to speak up and that this is viewed as a positive, welcome and vital act.

Our team have helped to champion the value of speaking up. We've highlighted available support and outline appropriate ways to support staff and respond to their concerns adequately, timely and safely.

Here are some specific examples:

  • We ran some face to face sessions giving staff a safe space to discuss how to raise concerns. Through these we identified enablers and barriers to speaking up. One of these sessions identified that a particular staff group didn't think that using the online incident reporting system was in their remit, or know how to access it. A trust wide approach was then used to train and empower these staff members to do so.
  • We've tried to aid more vulnerable staff groups in speaking up by including Black Asian Minority Ethnic (BAME) and night staff members in our FTSU team. We provide feedback to concerns raised and record these demographic details in our feedback questionnaire and database.
  • Recurrent leaks were detected in a clinical area, which was investigated and found to arise from the adjacent sewerage and pipe systems. The FTSUG raised the profile of this concern which resulted in swift action from the executive team. This was used as a case example in the 100 voices campaign of the National Guardian Office.
  • Overheating in another clinical department was affecting staff and patients. This was escalated to our service which resulted in the issue being dealt with.
  • Handover processes in a ward were reviewed and improved following concerns raised about handover practices and the seniority of team members taking referrals.
  • We've seen a reduction in calls to the outside organisation Safecall, with more staff members using our internal FTSU route.

In your experience, what are the biggest barriers to speaking up and how can these be addressed?

In my experience some of the biggest barriers include:

  • Moving on from a rotation
  • The fear of not being seen as a team player
  • The fear of damaging your career progression
  • And not receiving feedback once you've raised a concern.

Some individuals are less able to speak up and the system has to work for the most vulnerable. We've tried to address this by including BAME representatives and night staff in our FTSU team. We are independent as we are outside existing lines of reporting and divisions. Our team is also trained to advise on anonymity and engaged with staff members using a variety of communication channels.

How can doctors in leadership positions support others to speak up? What have you learned about listening well?

I've been struck by the integrity and personal experiences of staff who have raised concerns and I would value such an individual in my team going forward. We have a fantastic platform to support people speaking up. We can make speaking up business as usual and encourage people to raise things at an early stage by being approachable, open, honest and kind.

Here are some key things I've learned about listening up well:

  • The most common reason we hear for individuals not raising concerns is a lack of feedback. Taking time to feed back is of paramount importance and will help individuals feel valued and that their input is meaningful.
  • Actively listen and obtain the facts. Allow them to tell their story but obtain details on:
    • what has happened
    • who is involved
    • what is the harm
    • why they are concerned
    • what outcome they are looking for
    • who they have escalated the issue to already.
    Repeat back what was said.
  • Encourage individuals to keep current and accurate records of their concerns as without this information the case may be weakened.
  • Effectively communicate at all stages of the process.

What's your message to doctors to encourage them to speak up?

Be assured, you are doing the right thing by raising a concern in genuine faith.

We're all on the same side and want patient care to be safe. As doctors, we're the eyes and ears on the ground so have a fundamental duty to raise any concerns.

We know that tackling concerns at an early stage is best. Express yourself in a professional manner and set the right tone, no matter how upset or distressed you might feel. Writing this down may help you remain focused.

In summary, be positive, be specific and keep a paper trail!