Case study from the Freedom to Speak Up team at East Midlands Ambulance Service (EMAS) following their 5.0 percentage point improvement in the FTSU Index.

In the 2018 FTSU Index Report, EMAS had the dubious honour of being the worst performing Trust with an FTSU Index of only 68.2 per cent.

We knew from our NHS Staff Opinion Survey results and internal cultural audits that we had issues with our culture.

Some staff told us that they were fearful of reporting incidents and speaking up as they did not believe that they would be treated fairly. They also did not feel that action would be taken as a result. This perception of our workers was reflected in our low rates of Freedom to Speak Up referrals and the high proportion that spoke up anonymously.

Although our FTSU Index increased to 71.9 per cent in the 2019 Report, placing us in the top 10 most improved Trusts, we still remained second from bottom of all Trusts.

We knew that this needed to be urgently addressed. We have been working hard to create a just and learning culture for all our workers, putting our Trust Values of Respect, Integrity, Contribution, Teamwork and Competence into practice.

In 2020, we launched a new five-year Quality Improvement Strategy which in conjunction with our People and Organisational Development Strategy and Communications Strategy was aimed at improving our culture, making EMAS a place where people are proud to work.

In addition to recruiting a new Freedom to Speak Up Guardian and launching a Freedom to Speak Up Online Training module, we have introduced several initiatives to help support this.

Conversation Café

Pre-pandemic, the Chief Executive and executive team, along with department leads, visited various sites across our region on the “Café bus” with tea, coffee and biscuits to meet workers. The cafés are an informal opportunity for people to speak openly about concerns or issues that affect their working environment.

Once the pandemic began, the cafés changed to virtual meetings using a Facebook Live platform and allowed more people to attend. Workers are encouraged to ask anything they wish. Questions are answered live in the sessions where possible or responses are included in our weekly bulletin if not.

Learning from Events

The Clinical and Quality Directorate facilitate 45 minute fortnightly sessions via Microsoft Teams that all staff and volunteers can join. Cases are presented to share learning from when things go well as well as when they have gone wrong. Workers involved in the cases are supported to take part if they wish and the focus is very much on learning and supporting excellence in practice. A panel of subject matter experts are available, and questions are encouraged.

We continue to support a just culture where we will learn from incidents and concerns, supporting our journey towards a Care Quality Commission rating of ‘outstanding’.

We still have a long way to go but we are proud of just how far we have come.

It was a friend and colleague that signposted me to FTSU and I would highly recommend the same to another colleague [Worker feedback]

This case study was featured in the 2021 Freedom to Speak Up Index Report. You can read the report and more case studies here.