The speaking up culture at Lancashire and South Cumbria NHS Foundation Trust has developed positively since 2017, with increased reporting from workers year on year.
The Trust appointed a full time Freedom to Speaking Up Guardian in 2020 to focus upon the embedding a Speaking Up culture. Key to this work was the development of a reporting system that provides a safe space for staff to share their concerns across all the services within the Trust.
Initially using their Datix reporting system, now Ulysses – the incident reporting system used by most NHS organisations – concerns can be reported by workers into a secure page on the system, which immediately alerts the Guardian for their review. The Guardian can then review the concern and immediately alert executives, locality triumvirates, senior leaders within services. In cases of patient/worker safety concerns, assurance and any immediate action is required with 24 hours or sooner.
The reporting system is accessed through a Freedom to Speak Up icon installed on every trust computer desktop. The system allows workers to share their identity or remain anonymous, and to signal any neurodiversity needs, so the Freedom to Speak Up Guardian can align the appropriate communication and support to deal with their concern. Once a concern has been reported, the Guardian then contacts senior leaders – a triumvirate of Medical Director, Director of Nursing, and a Director of Operations, in each locality, and requests the matter is investigated, providing a response within 10 working days or less.
The Guardian uses the reporting system to run a weekly reporting dashboard for each locality. The services can then triangulate their own data, take ownership of any issues and make plans for self-improvement. The Datix system also allows for triangulation of information to proactively identify hot spots areas of concern within the Trust. The Trust produces heat maps, which are shared with the services monthly and used along with other assurance methods to look for areas of best practice and improvement.
An open culture is the expectation that people will be supported to speak up for the benefit of patient safety and the organisation’s culture; at LSCFT, this starts at the top. To further support the Trust to achieve a speaking up culture, CEO, Chris Oliver, has a ‘Contact Chris’ page that staff can directly share with Chris. This simple but effective demonstration of openness makes the executive team more accessible and visible throughout the Trust, and role models a Listen Up, Follow Up leadership culture.
To further ensure this, the Trust has implemented the national Freedom to Speak Up training as mandated learning, with a high percentage of compliance. Freedom to Speak Up is included in all staff inductions and the Trust has ensured there is a diverse and active Freedom to Speak Up ambassador network across the Trust, covering the major sites and services. The Board’s Senior Independent Director, Paul Farrimond, is the Non Executive Director for Freedom to Speak Up and he meets regularly with the Guardian, Executive lead and Chief Executive, again re-enforcing the importance of this agenda within the Trust.
Ursula Martin, Executive Lead for Freedom to Speak Up said, ‘The Trust has come a long way over the last few years regarding having a psychologically safe and Just Culture, one where concerns from staff are welcomed so we can take action and make improvements. We know there is more to do but speaking up safely is a big part of our improvement journey and we look forward to continuing the work we are doing and seeing the impact for patients, families and staff’.
Ken Levins, Freedom to Speak Up Guardian said, “Our vision for Speaking Up at Lancashire & South Cumbria Foundation Trust is to be the organisation that is the best at listening to concerns, the best at learning from concerns, and the best at keeping our patients and staff safe.”