Speaking up for an open culture

David Hare reflects on the importance for independent practitioners of speaking up in order to report mistakes and drive improvements in healthcare.

‘Speak up Month’ in October provided an ideal time to reflect on the importance of all parts of the healthcare system – including the independent sector – embracing the ‘speaking up’ agenda as a way of improving the safety and quality of care. 

And this year’s theme, ‘Freedom to Speak Up for Everyone’, was a welcome reminder of the need to make speaking up business as usual for everyone in the health service: NHS or private, from consultants to healthcare assistants. 

And as an ambitious sector with a strong culture of learning, independent providers and practitioners have much to feel proud of in fostering open, just and learning cultures where speaking up is encouraged.

Indeed, the National Guardian’s annual Freedom to Speak Up survey published earlier this year showed that independent healthcare providers have seen a real improvement in the speaking up culture in their organisation over the last year. 

Overall, the report found that almost four-fifths (78%) of resp­ondents from independent healthcare providers said their organisation’s ‘speaking up’ culture had improved over the last 12 months. 

Freedom to Speak Up Guardians in the independent sector were also found to devote more of their time on the ‘proactive’ aspects of their role – such as working within their organisation to tackle barriers to speaking up – than the reactive aspects; for example, supporting workers who speak up to them. 

Proactive aspects

Over 70% of Guardians in the independent sector spend at least half of their time focusing on ‘proactive’ aspects, compared with just over 50% of those from NHS Trusts and other parts of the healthcare sector.

While, of course, it is encouraging to see independent healthcare Guardians working so proactively in the sector, there is still much more to do on this agenda to ensure speaking up is fully embraced by independent practitioners all across the country. 

To help support the sector on this journey, we were pleased to be joined at the Independent Health­care Providers Network’s annual Patient Safety Conference this year by the National Guardian for Freedom to Speak Up, Dr Jayne Chidgey Clark, who spoke about how providers can better understand the importance of speaking up at all levels in their organisation. 

This includes really interrogating and acting on the data that providers collect in their organisations – for example, looking at what the rate of ‘anonymous’ cases are and what this might indicate about an organisation’s speaking up culture. 

Equally, understanding what the organisational routes are for speaking up and what barriers there might be in place throughout different parts of the speaking up journey will be vital in encouraging a more open environment. 

Getting feedback

Getting feedback from people and groups who have spoken up and ensuring organisations ‘close the feedback loop’ is also key.

And above all, having curiosity about your organisation’s speaking up culture and really reflecting on these issues from the top of the office down so that all parts of the organisation feel confident and able to speak up is an integral part of this journey. 

This is so important in healthcare – a sector which, unfortunately, can be seen as hierarchical and top-down.  

Freedom to Speak Up Guardians not only provide a structure for concerns and issues to be raised, but also help develop a culture where employees feel free to contribute ideas, share information, and report mistakes and ultimately drive improvements. 

Independent healthcare practitioners know that a key part of improving the care they deliver to patients is to interrogate their performance, to speak up and challenge poor performance wherever it may be. 

I urge all those working in the independent healthcare sector to raise awareness of Freedom to Speak Up Guardians and encourage many more to be established. 

Not only will you be fostering a culture where people can speak up and be confident they will be listened to, it will play a pivotal role in further improving the care you provide to millions of patients every year.

David Hare (right) is chief executive of the Independent Healthcare Providers Network