Freedom to Speak Up: hospice values in action

Creating a Freedom to Speak Up culture means that everyone feels confident they will be listened to when they speak up, and action taken.

As a nurse specialising in end of life care, in my experience hospices work towards a ‘one staff concept’ – wanting to be inclusive of workers, whether they are staff or volunteers. That means wanting to make sure that everyone feels their voice is important. The pandemic showed us how critical it is that speaking up and listening up is a dialogue between workers and their organisations. 

It is a reflection of how psychologically safe people feel, that they are able to speak up, feedback, and work together to innovate and perform effectively. So, there is a strong case for encouraging a Speak Up culture and helping it to flourish.

Every year in October we celebrate Speak Up Month – a month to raise awareness of Freedom to Speak Up and make speaking up business as usual for everyone.

The theme for this year’s Speak Up Month is Breaking Barriers, because we know that there are many things which can stop people from speaking up.

Being afraid of what might happen or feeling that you won’t be listened to can stop people from speaking up. Workers may be worried because of their background, their heritage or their experience. They may feel they might not be listened to because of their lack of seniority, their circumstances or their job role.

This October we will be raising awareness of some of the barriers to speaking up. By highlighting them, we hope to give people the confidence to overcome these barriers and make speaking up business as usual.

Raising awareness of the barriers to speaking up is also an opportunity for leaders across the sector to understand and work to address and remove them. This will help foster an inclusive environment that encourages speaking up, listening up and following up.

While there are many existing ways for workers to speak up – including through incident reporting mechanisms, via their line manager or educational supervisor or human resources - there may be occasions where none of these channels are suitable or trusted. Sometimes people may be fearful that they might be victimised for speaking up or they have tried to raise matters before and been blocked or ignored, or as volunteers they may be uncertain of who to speak to or even whether they can. 

Freedom to Speak Up guardians provide an additional channel for workers, volunteers, students, trainees, contractors, partners and others, and work proactively to support a positive speaking up culture.

There are now over 1,000 Freedom to Speak Up guardians in England, over 9 per cent of whom work in hospices. The National Guardian’s Office supports this network of guardians through training and guidance and supports the wider health system by facilitating opportunities for sharing and learning, disseminating good practice and providing challenge to tackle barriers to speaking up.

Guardians act impartially and independently. They thank workers for speaking up, listen, offer support, act to preserve confidentiality where requested and if possible, and ensure action is taken and feedback given. Guardians have anecdotally described to me the positive impact of speaking up and listening well in their organisations, whether that be about patient care, or a reduction in staff sickness absence, fewer grievances, improved staff survey results and better engagement of senior leaders.

Speaking up is about anything which gets in the way of good care. 

Over 100,000 cases have been brought to Freedom to Speak Up since they were first implemented. Cases with an element of patient safety, worker safety, bullying and harassment and inappropriate behaviours. This matters, because we know that incivility in the workplace has a negative impact on patient care. 

For hospice leaders, Freedom to Speak Up guardians provide an opportunity to understand what matters to workers. By sharing the themes of the cases which are coming to them, their insights can provide opportunities for improvement and an early warning system of where the stresses and strains are within the organisation, before problems become crises, which could impact upon patients, workers and the hospice’s reputation or finances.

Making sure that Freedom to Speak Up is available to all workers is vital, especially in hospices who rely so much on volunteers, who may not feel that the usual speaking up routes are available to them. 

To help ensure that all workers – whether staff, volunteers, agency, clinical or non-clinical – understand how they can speak up, the National Guardian’s Office, in association with Health Education England, has developed a free e-learning resource available for everyone wherever they work in health. It explains in a clear and consistent way what speaking up is and its importance in creating an environment in which people are supported to deliver their best.

The first module – Speak Up – is for everybody. The second module, Listen Up, for managers, builds upon the first and focuses on listening and understanding the barriers to speaking up. A final module, Follow Up, for senior leaders supports the development of Freedom to Speak Up as part of the strategic vision for organisations and systems.

As values-led organisations, hospices have care at their very heart, and that extends to their care for workers. A supportive Speak Up, Listen Up, Follow Up culture is one where all of us should be able speak up about anything.

Where we can share ideas, seek support, offer feedback, challenge decisions or speak up without fear of repercussions. The Freedom to Speak Up means we can ask questions where we might be uncertain and share positive practices that can be cascaded elsewhere in the organisation. 

Together we can make speaking up business as usual.

If you would like to get involved with Speak Up Month or find out more about Freedom to Speak Up or the details of your Freedom to Speak Up Guardian, visit the National Guardian website.