Exclusive: Survey shows NHS not there yet on raising concerns
More than a third of nurses believe the culture around raising concerns has improved at their employer in the last 12 months – but many still report negative consequences from doing so.
Nearly half of nurses that have raised a concern about patient safety in the last year say it has led to negative repercussions for them personally, according to a survey by Nursing Times.
The findings of our survey of nearly 500 nursing and midwifery staff suggest that, while there have been some improvements in this crucial area, there remains a long way to go before the NHS has a widespread culture that welcomes and supports its staff over raising concerns about the safety of their patients.
This time last year we launched the Speak Out Safely campaign in the wake of the Francis report into care failings at Mid Staffordshire Foundation Trust, which revealed the dangers of not responding to concerns from staff. The report was subsequently followed by several other high profile reviews – by patient safety expert Sir Don Berwick and NHS England medical director Sir Bruce Keogh – that made similar warnings.
We aimed to raise awareness about the problems staff faced when raising concerns and to persuade employers to take concrete action to support them, rather than ignore or reprimand them, or allow them to face bullying and harassment.
To mark the campaign’s first anniversary we have surveyed readers on the issues surrounding their ability and experiences of raising concerns to gauge what had changed, if anything, since these seminal reports were published and since we carried out a similar poll last March.
Nearly two-thirds of respondents, 62%, said the healthcare sector could “be a lot better” when asked how they felt generally about their ability to raise concerns. A further 32% said it “could be a bit better”.
This suggests some improvement compared to last year, when 80% said it could be a lot better and 18% a bit better.
Asked whether the culture of their organisation had changed over the last 12 months, 37% said it had improved “significantly” or “a bit”. However, half reported no change and, worryingly, 13% said things had “deteriorated”.
Risk of being viewed as a troublemaker was the biggest barrier to raising patient safety concerns, according to 23% of respondents – also the main barrier cited by readers in our 2013 survey.
One respondent said: “I strongly feel that in my experience we are considered as being difficult if we raise concerns at ward level.”
Another said a colleague who tried to raise concerns was told by a doctor “they did not want to hear anything in the wider team ‘or else’ – she took the ‘or else’ to mean keep her mouth shut!”
A further 20% said the biggest barrier was a failure to act on concerns by senior managers and 18% cited a failure to act by line managers.
However, on a positive note, a quarter of respondents said there were no barriers to raising concerns where they worked.
Just under half, 48%, said they had raised a patient safety concern with a line manager or senior manager over the last 12 months.
The majority of concerns, 38%, were about staff shortages, while 33% were about a colleague’s practice and 23% a colleague’s attitude.
Unfortunately, 50% of respondents who raised a concern said it did not lead to an “appropriate outcome”, compared with 30% that said it did and 20% who did not know.
More worrying still, 47% said that raising a concern had resulted in “negative consequence” for them personally – though 9% also said it had led to “positive consequences”.
One respondent said: “If someone reports someone for bad practice, then it almost turns into a ‘witch hunt’, where other staff spend their time checking the person who was doing the reporting’s paperwork and picking fault with every minor detail.”
Despite these continuing issues, the survey gave a positive message that suggested nurses would be undeterred from continuing to raise concerns about the safety of their patients.
In total, 96% of respondents said they would be prepared to raise concerns. More than half, 50%, said they would always do so and 46% they would do so sometimes, depending on the seriousness of the situation.
In addition, among those that told us they had raised a concern in the previous 12 months, 64% said they would “definitely” do so again and 26% they would “probably” do so.
The annual NHS Staff Survey, published last week, also asked questions on raising concerns. It found 73% of staff would feel safe raising concerns but only 57% said they would feel confident their organisation would address them.
- Find out more about the Speak Out Safely campaign, including its aims and targets, and who supports it.