Speak Out Safely is an important campaign if we are to develop cultures that are honest and transparent, says Helen Lockett
Like many NHS trusts, Liverpool Community Health Trust has signed up to support Nursing Times’ Speak Out Safely campaign. This aims to ensure that healthcare providers listen to, support and value staff who raise concerns about the quality of care, and learn from the issues they raise.
Working in the NHS, after the Francis, Keogh and Berwick reports, I believe it is an important campaign if we are to develop cultures that are honest and transparent.
It is every nurse’s professional and moral duty to report care failings. As Edmund Burke, the Irish political philosopher, famously said: “All that is necessary for evil to succeed is for good men to do nothing.”
We need to actively encourage staff to raise the alarm if they see poor practice and to protect them when they do so. I have written previously for Nursing Times on one of the chief nursing officer’s 6Cs - “courage” (“Have the courage to challenge others,” nursingtimes.net). It does take a great deal of courage to raise concerns because we fear reprisal or exclusion from the team. It takes a great deal of courage to put our heads above the parapet.
“Staff who were courageous enough to stand up for patients must be protected and be seen as positive role models”
In any of the high-profile cases of institutional failings, before and after Mid Staffs, there were always staff, as well as patients and carers, who did raise the alarm - but no one listened. Without those people, the extent of the failings would not have come to light. They acted in the best interests of patients and exercised their duty of care - and duty of candour.
Staff who were courageous enough to stand up for patients must be protected and be seen as positive role models. At Liverpool Community Health Trust, we encourage staff to use the following channels to raise concerns: line managers; the director of nursing; board non-executives - these people are not employees and it is their role to be an independent yet critical friend to the trust; trade unions; the clinical commissioning group chief nurse; the national whistleblowing helpline - 08000 724 725; and the Care Quality Commission.
It is the responsibility of senior management to ensure people feel supported and that they will not suffer reprisals for raising concerns or incident reporting. If nurses feel reporting concerns is the norm and good practice, they may not feel the need to blow the whistle. Whistleblowing should feel like a last resort when all other avenues have been exhausted.
Organisations and employers need to develop the culture where staff are listened to and their ideas implemented. This is not easy to achieve in large organisations, but can be achieved through:
- Creating forums for professionals where they can learn from good practice and share ideas;
- Developing line managers to feel skilled and equipped to challenge poor practice and listen to ideas and concerns when they are raised;
- Using techniques such as appreciative enquiry and coaching so every mistake or incident is a learning opportunity and does not necessarily result in a disciplinary;
- Using structured programmes such as Listening into Action, led by clinicians.
We need to create an environment in the NHS where all organisations can learn from the best and aspire to be the best.
The Berwick report stated: “Fear is toxic to both safety and improvement.” This quote is true, for both individuals and organisations. People must feel safe and be protected if they raise concerns. Organisations also need to feel safe from reprisals such as reputational damage, to be open and transparent about their failings and be supported to learn and continuously improve the quality of their care.
Helen Lockett is director of operations and executive nurse at Liverpool Community Health