1. National Guardian Freedom to Speak Up
Freedom to Speak Up Guardians – what is their role in improving the learning environment
Dr Henrietta Hughes
National Guardian for the NHS
@NatGuardianFTSU
#FTSU
What are Freedom to Speak up Guardians?

2. Think of your best teacher at school

3. Speaking up is about learning and improving
“As the world changes, there is one constant truth: only those who adapt can survive. Agility, and a willingness to innovate, are not just useful extras, but central to growth. The great institutions and successful individuals are adaptive for a simple reason: they realise that in a complex world, they don’t already have all the answers. They are therefore not threatened by information about their weaknesses. Indeed, they actively look for them.”
Matthew Syed
Author, ‘Black Box Thinking’

4. Working in partnership

8. Trainees Leaders of the future Fresh eyes
Contribute to quality improvement
Leaders of the future
Feedback formally via surveys and informally at handover
Ability to learn within a nurturing environment

9. Competence vs conduct
Good
Competence
Poor
Conduct
Poor
Good

10. In the news

11. Case study – Junior Doctors Gripe Tool
Following a positive Listening to Action event, University Hospital of Leicester designed the Junior Doctors Gripe Tool.
The aim of the Gripe Tool is to ensure there are no barriers for junior doctors to raise their concerns.  
Once a gripe is received, it is acted on, and feedback is provided to the doctors individually.
Categories for raising a gripe include: lack of staffing resources, IT issues, equipment and ward environment, safety of care.
Since 2015, 248 Junior Doctors have accessed the Junior Doctors Gripe Tool.

12. Case study – Action learning set
An Action Learning Set is a group of peers who have similar levels of professional responsibility who meet regularly with a facilitator eight to 10 times over a year.
The facilitator’s remit is to establish the ground rules, create a safe environment for individuals to explore sensitive issues, help draw out learning and enable the set to reflect on group processes.
Action Learning Sets focus on speaking up processes to help formulate plans, explore new ideas, achieve results and develop leadership skills in the workplace.
Helen Auld ran an Action Learning Set at the East Midlands Freedom to Speak Up Guardians Regional Network

13. Case study – Trainee anaesthetists
Association of Anaesthetists of Great Britain and Ireland undertook a quality improvement project to reduce the impact of fatigue amongst trainee anaesthetists at the Royal Victoria Infirmary in Newcastle.   
Trainees held a focus group to see how they could raise awareness of the risks around fatigue, poor team working and individuals driving home tired. Further action has been taken to address all of these areas.
There are some early signs of cultural change; nursing staff discuss fatigue in the coffee room, trainees challenge their consultant during a 3am emergency case about coming into work the following morning.

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15. Annual report 2017

16. Links National Guardian’s Office email address–
Annual report 2017 –
Case review (Southport and Ormskirk Hospital NHS Trust) –
Q2 2017/18 (July – September) data table –
Freedom to Speak Up Guardians’ Survey 2017 –
Freedom to Speak Up Guardians’ Directory –