A breakdown in communication led to a clinical instruction being overlooked and a potential delay in care.
On learning of this, a Consultant spoke to the nurse in charge (NIC) with a raised voice in front of other workers and fellow Consultants. In this interaction, the (senior) Consultant’s overall tone, demeanour and choice of words were described as wholly inappropriate and caused the nurse to become distressed.
The incident was reported to the Ward Manager, who met with the worker immediately to offer their support. Upon seeing the NIC’s distress, another Consultant reviewed the clinical care and established that overall good care had been given. This Consultant took time to listen to the NIC and provided reassurance that they would approach their colleague to address the tone of their communication.
Aware of the opportunity for the hospital to learn from this experience, the Ward Manager referred the matter to one of the facility Freedom to Speak Up Champions who escalated to the facility Executive Team and the Freedom to Speak Up Guardian.
On learning of the distress caused by their communication, the Consultant approached the NIC and apologised for their behaviour. They met the Executive Leaders and the hospital’s Medical Director who reiterated his expectation that all hospital colleagues are treated with dignity and respect at all times.
At the hospital’s Ethics and Compliance Committee (to which the Speaking Up Champions are invited), the matter was discussed, and the hospital’s leadership team has asked the Freedom to Speak Up Guardian and HCA’s Learning Academy to consider developing training for all nursing staff on the importance of being an ‘Active Bystander’: that is, encouraging staff and colleagues to call out inappropriate behaviours that they witness at work, and to support the reporting and investigation of any incidents.
If this is successful, HCA UK are considering rolling out similar training to all their hospitals to drive the culture of speaking up at all levels. As a result of a number of concerns raised (including this one), promoting a culture of respect and civility based on reinforcing a ‘no tolerance’ approach to rudeness and aggression is to be included in the next iteration of HCA’s mandatory ethics and compliance training, which is taken annually by all workers, including doctors.
The Freedom to Speak Up Guardian said, “We know that some people do not care how their behaviour affects others, but some may not even realise that their behaviour is offensive. If people with problematic attitudes are not confronted about the effect their behaviour has on others, there is a real risk that their behaviour becomes tolerated, and even ‘part of the culture’ of that team, ward or hospital.”
Speaking up takes courage but is the essential first step in challenging aspects such as intimidating behaviours and alerting the people who are in a position to listen and follow up concerns. If this is done openly and with minimal delay, the subject matter of the initial report will often be willing to support the learning outcomes with a view to preventing the next stressful situation turning into an embarrassing one. In this case, the reporter also provided very positive feedback about their speaking up experience.
None of this would be possible, though, without the correct tone from the top: HCA UK’s hospital Executives and Leaders are committed to listening to concerns and action in response – regardless of an individual’s seniority, importance or reputation.
This case study features as part of our 100 Voices campaign. If you would like to share a speaking up story for this campaign, please contact [email protected] for more information.
Tim Graveney, Ethics and Compliance Officer, HCA Healthcare UK