Freedom to Speak Up Handling Concerns: A practical guide for managers By Caroline Owens Freedom to Speak Up Guardian, Brighton and Surrey University Hospitals NHS Trust

Hot Potatoes and How to Handle Them Freedom to Speak Up Hot Potatoes and How to Handle Them

Getting Ready Freedom to Speak Up I’m busy right now, come back later here is a lot to consider when you become responsible for managing other people in the work place. But what will you do if someone comes to you and tells you about something they have seen that worries them? You have choices….. I’m busy right now, come back later Agghhhh what do I do Ignore it will go away I can’t talk now, but this is important ………… Let’s talk Oh here we go again they always find something to pick at When people talk to you about things that concern them, the issues can be small and easily resolved or can have significant and challenging consequences. Anyone who has had a hot potato straight from the oven, will have learned to handle it so they don’t burn themselves, but they do get the prize of hot fluffy cooked potato. It is the same with concerns if you learn in advance what to do and how to behave, you will get the prize of building an open culture and running a team who are confident to share concerns early enabling you to lead an engaged team delivering a great patient experience.

Know now Freedom to Speak Up TASK Familiarise yourself with where you can find things: Policies and Procedures are located on the Info-net Have a list of useful phone numbers:- your HR support Team, Freedom to Speak Up Guardian, Safeguarding Teams, Fraud, Security, etc. Know the organisation structure of your department, if your line manger isn’t available and you need help where do you go next Ask your Freedom to Speak Up Guardian to run a workshop You don’t have to know everything, but knowing where you can find information helps build confidence when supporting staff raising concerns. What happens if……………… The concern is unfounded – if the person bringing it genuinely thought there was an issue, that is fine, explain to them everything is ok, and thank them for caring enough to be prepared to speak up. Do give some thought as to why it appeared as though something was wrong, do you need to make changes? There isn’t much evidence – if you have read the policy you will understand that it isn’t necessary to have lots of evidence to support a concern, the fact that someone thinks they have seen something which compromises patient safety or puts the Trust at risk is enough. They are making trouble – This is a common concern that staff may use raising concerns or whistleblowing policies to ‘get at’ a colleague. This is highly unlikely, however if on investigation it should prove to be the case, then talk with HR and follow through the disciplinary policy.

Practice some skills Listen Act Feedback Freedom to Speak Up The art to successfully dealing with a concern is to LAF Listen Act Feedback Listen – this is the bit you need to do to understand the issue – it happens in your first meeting Find an appropriate quiet place where you can hear try to be relaxed and attentive Ask questions to find out details, and keep an open mind Repeat back, or summarise to check you have understood Don’t interrupt Reassure and don’t be judgemental Don’t jump to solutions Make notes you may need them to help with resolving the issue TASK Check out https://www.forbes.com/sites/womensmedia/2012/11/09/10-steps-to-effective-listening/#658d9bf83891 for Dianne Schilling’s article on 10 Steps to Effective Listening Act – once you understand the issue you work through how to resolve it – this could take be a matter of hours or a few weeks Thank the individual for raising their concern Do they have ideas to resolve the problem – explore them. Agree what will happen next Agree a timescale Check out the policy. If you need to take advice do it – don’t be afraid to ask for help.

Listen Act Feedback Freedom to Speak Up Act continued… If the issue is serious with a risk to patient or staff safety or the wider organisation you may have to pass it on for formal investigation – talk to your line manager, or the person responsible for the area the concern relates to. Keep the member of staff informed on progress, and make sure they are ok. Remember depending on the concern they may be feeling very vulnerable Sometimes a concern raised may be uncomfortable for you to hear and have to deal with. Try not to let that impact on your behaviour to the staff member It isn’t always appropriate to share detail, that is fine but check in and let them know it is being dealt with When the matter is resolved reflect on the lessons which have been learned Feedback – this happens promptly once resolution has been reached and is an informative concluding conversation Feedback to the individual the outcome (within the realms of confidentiality) and tell them about the lessons learned If the concerns have led to improvements in patient care acknowledge that and give credit to the individual and with their agreement share the story about the benefit of raising a concern Openly thank them for having the courage to speak up

Listen Act Feedback Freedom to Speak Up Feedback continued… Feedback is a really important part of the process. Without it, you risk wasting all the effort you used to resolve the issue. Feedback is the concrete end which shows you listened to the problem, you took the situation seriously and you did something about it. Difficult Feedback – sometimes an issue or problem is not going to be resolved, and that needs to be explained. This is crucial otherwise it will be assumed you are ducking the issue. So if nothing is going to change explain why not, acknowledge the issue has been heard and understood – the Trust is aware. Is it a forever reason? If not, say so, indicate when it will be reviewed (make a diary note and follow through) TASK You may want to give some thought to the kinds of things that are issues and difficult to resolve – you know what they are, reflect on how you would respond to your team if they raised a concern. Think is this something the Trust knows about but is a ‘do nothing’ situation? Do you understand why? If not find out, you may have to explain one day!

In the Moment Freedom to Speak Up This is it someone has approached you and ask if they can talk to you about something. Raising concerns may come out of the blue to you, but the chances are this member of staff has been thinking about talking to you for a while. They may be nervous, emotional, abrupt, or even aggressive this is a sign they are worried. Try your best to reassure them. Employ Listening part of LAF Employ your listening skills. Don’t try to explain or justify. Thank them for speaking up. Acknowledge they may find speaking up difficult. Make notes and check back you have understood the issue they are raising. If you need to take advice, tell them, and agree when you will come back to them ideally later in the day or the next day. If this is a concern which requires formal investigation then explain what will happen. If you can deal with it – say so Thank them again reassure you take their concern seriously and say you will stay in touch and confirm your next steps Now have done L you are ready to deliver A and F Remember Be up front and ask if the member of staff is bringing their concern to you openly or confidentially Open – if others need to be informed to resolve the situation you can share the identity of the person raising it Confidential – you have agreement to share the identity of the person raising the concern with a named person or persons but to share with anyone else will require consent

Building a speaking up culture Freedom to Speak Up What’s next Make sure you follow the policy appropriately if you are dealing with a formal raising concern, whistleblowing issue, and write to the member of staff using the pro forma letter. Just remember this may be the scariest thing that your member of staff has done in a long time. Ensure you keep in touch with them throughout the whole process. Don’t allow them to be shunned or treated badly because they took the decision to call out something that concerned them. Follow through and share the learning. Empower the person bringing the concern to share outcomes if that is appropriate in the circumstances. Celebrate improvements you make to your service, patient care etc. as a result of listening to and acting on a concern Building a speaking up culture You can be instrumental in building a culture where raising concerns, learning from each other and improving the patient experience is the way your department works. How can you give your team an opportunity to talk about good practice, identify things that could be done better, call out issues requiring more training, talk through when things have gone wrong and what can be learned? How effectively is knowledge shared not just about the department but also the wider organisation, can your team put things into a wider context, understand the big picture? This helps to understand why it may not be a priority to change something. Does your department actively display values that encourage openness and honesty? Think respect, fairness, courtesy transparency.