by Stuart Poynor (CEO) and Helene Donnelly (Ambassador for Cultural Change), Stoke and Staffordshire Partnership NHS Trust
Raising concerns...
There are lessons to be learnt from the focus on safety in the aviation, and other, industries (e.g. nuclear, automotive), where people are expected to raise concerns. Even if it’s your error, you are thanked for raising it.
As a trust, we know that we don’t always have all the information on an issue with which to fully appraise it. We have run focus groups with nurses, under Chatham House rules, out of which can tease out major issues and concerns. Through this we can piece the jigsaw together to see if there are other unrecognised issues.
However, sometimes staff don’t even know if they’ve got a concern – this is a cultural issue.
Read more about our work around raising concerns on our website.
An ambassador for cultural change...
Helene has taken on the role of Ambassador for Cultural Change – we strongly believe that all trusts should have this role.
To be successful, the role needs:
- A recognised role nationally - so as not to cause confusion – people move round a lot (e.g. junior doctors) and need to know where to go if they have a concern.
- Whoever does it to have complete autonomy - to go anywhere and speak to anyone.
- To report directly to the CEO and board - possibly an additional member from the board who can take on responsibility of linking in with the role.
All organisations will have people who feel let down, and not supported. We need to create someone independent of management to listen to and support staff. And also, to bring together other mechanisms staff have to speak out (unions, professional leads, line managers), to make sure that all of these mechanisms work well, and if not, put some correction into the system.
The role of Cultural Ambassador complements what is working well, and also helps to fix what isn’t.
You can find out more about Helene’s role on our website, or see a video of us discussing the work.
The 'Raising Concerns Helpline'...
We established a phone number which staff could call to contact Helene directly. In eleven months 87 people called the helpline, versus just 3 people who had contacted our previously advertised independent number in the same timeframe.
But Helene doesn’t just wait for calls to come in, she goes to people directly. This can nip things in the bud, it’s a preventative measure. And it’s not a whistleblowing helpline, the role is specifically about culture change. It’s important to celebrate success, but also to pull people up on poor practice, right up to the top (even the CEO!).
Don’t say you’ll do something if you won’t be able to do it…
In the spirit of the duty of candour, we need to ask why aren’t we getting things right? It’s not just about people raising concerns; sometimes people say they don’t have a problem and are in denial.
Coming into and organisation with no understanding of policy and process is actually a good thing, to look at it objectively and see the issues. It’s a useful exercise to be able to condense a policy down to one side of paper.
And this is something we see that CQC could use as part of the inspection process. When they come in, they could ask: “Where’s your ambassador?”, and “What’s your ambassador like?” – it’s another resource to find out more about culture.
A network of peer support and review...
We would like to see a national network of Cultural Ambassadors, with information from this group feeding into CQC, NMC, Monitor, GMC etc… again, with a view to taking preventative action.
It would be possible to ask other Cultural Ambassadors: “Could you come and have a look at this, am I right?” We need ability to bring this information together nationally; there is a lot of talking at the moment about speaking out.
What came out of the Francis Report was the concept we should be doing more to listen to patients and staff. At the recent whistleblowing conference hosted by CQC, Helene was told “If only we’d had someone like you”. A program of support for people who have raised concerns and had issues is keenly needed.
Benefits for the organisation...
Benefits (a lot are financial)
- Prevent disciplinaries, or ensure they happen where appropriate.
- Save money (litigation, employment tribunals).
- Issues around bad processes being followed.
- People on the verge of going off sick/through stress prevented.
- Patient safety.
- Staff feel supported.
- Raising staff morale.
- Making staff feel valued and consulted about the decisions which affect their service delivery.
Common themes / issues
- Address them before it becomes a problem.
- Can’t cross every 't' and dot every 'i'.
- Safety net.
Raising concerns should become a mandatory training requirement, and be included at trust inductions. There should be one NHS Raising Concerns policy.
It’s important to report back each month to the executive management team on themes and issues. And reporting back to the CEO directly gives staff confidence.
To any trusts who say “we don’t need this role, we don’t have any issues”, I say: “Give me an afternoon in a trust and I bet I would come away with something…”
Helene’s new role...
Helene will also now be working with Health Education England, to devise structured statutory training for all NHS staff on how to raise concerns and to ensure they have the information to know which routes and avenues to take if the usual methods fail.
To instil the leadership required to support staff when raising concerns and ultimately ensuring patient safety.
Live Q&A Session on the CQC online community: Speaking out Safely – Raising Concerns
On Tuesday 3 June, Helene and CQC’s National Advisor for Patient Safety, James Titcombe, held a live Q&A session on the CQC online community for providers and professionals.
You can see a record of what was discussed on the day by logging into the online community and going to the discussion thread. If you’re not a member of the CQC online community you can sign up here.
Word cloud from the day...
