At Royal United Hospitals Bath (RUH), Freedom to Speak Up Guardian Louisa Hopkins has been working to embed Freedom to Speak Up into business as usual. Her work led RUH to be shortlisted for the Freedom to Speak Up Organisation of the year at the 2022 HSJ Awards.
The leadership at RUH acknowledge that Freedom to Speak Up is about culture change. Placing long term goals in a workable strategy has given a framework to acknowledge that true culture change needs time, trust, and an understanding of the current culture and barriers to build much needed psychological safety. In governance terms, Freedom to Speak Up sits under organisational culture and learning and change of emphasis has helped incorporate support for speaking up into managerial practices throughout the organisation.
This began at RUH by making the Freedom to Speak Up eLearning modules part of essential training for everybody. As a mandatory part of training, all workers complete the ‘Speak Up’ and ‘Listen Up’ e-learning modules produced by the National Guardian’s Office in collaboration with Health Education England. This included within Junior doctors’ induction training and in all workers essential training. These modules help to ensure workers know what to expect when they speak up and that managers understand the supportive approach to take when someone speaks up to them. Over sixty percent of the workforce have now completed the training, above the initial target RUH had as part of its three-year plan.
It was important to the Freedom to Speak Up team that people who had traditionally been seen as ‘hard-to-reach’ were consciously engaged with, to ensure that they felt that their voices matter. Louisa, in her former clinical role, had herself worked nights for 6 years and understood how out-of-hours workers sometimes feel isolated from their Trust and leaders. The Freedom to Speak Up team set out to ensure that all workers felt equal to all other colleagues in their opportunities to speak up in a safe and welcoming environment. They ensured they were visible and available to these workers by incorporating early starts or late finishes, and weekends, including an ‘out of hours month’. This meant that Freedom to Speak Up feels available to everyone, no matter what their shift patterns.
This understanding of the clinical mindset has also helped Louisa identify ways to weave Freedom to Speak Up into the very fabric of ways of working in the organisation. For example, RUH has an EXCel programme – working toward excellent care at every level. In the programme of ward accreditation, Louisa saw an opportunity to embed the support of speaking up into the quality indicators, so that speaking up, listening up and following up were seen as integral to good ward management.
So many lessons have been learnt as a result of this work to embed Freedom to Speak Up. Some are easy to capture and are found in reports of change such as a department where 13 staff spoke up sharing their story which influenced the Trust to increase their staffing figures and invest financially in the area. Other learning is found in managers personally reflecting due to one of their team speaking to the Freedom to Speak Up guardian because they met barriers to speaking up in their team.
By embedding Freedom to Speak Up into daily business practice, speaking up is on its way to becoming recognised as ‘business as usual’ at RUH. There have been an increased number of cases coming to the Freedom to Speak Up guardians and there has been a reduction in anonymous reporting. 94% of respondents share that they would speak up again.
Louisa is now moving on to a new Freedom to Speak Up Guardian role in Gloucestershire Hospitals NHS Foundation Trust but about the HSJ awards shortlisting she said: “At the RUH we have worked hard to look for every opportunity available to embed the Freedom to Speak Up process, to understand staff’s working patterns and make Freedom to Speak Up accessible and inclusive to all staff, wherever and however they work. We have raised the profile of speaking up in the RUH, ensuring all staff know they have a safe space to talk in the Freedom to Speak Up Team. I am so proud of the Freedom to Speak Up team and all we have achieved in being short listed for the HSJ awards.”