Staff at the Royal Preston and Chorley and South Ribble hospitals who have concerns about their working environment or patient safety are being encouraged to share them – without fear of any fallout.
Lancashire Teaching Hospitals (LTH) has revised its Freedom To Speak Up (FTSU) policy – and plans to make greater use of mediation to resolve problems.
Seventy-five individuals have brought issues to Steve O’Brien, the trust’s FTSU Guardian, over the past twelve months – with the number coming forward increasing in three out of the four quarters.
Steve suggests that the figures do not necessarily indicate a deteriorating situation – and that they might simply reflect the more open culture which he is trying to forge. But he is keen for that culture shift to extend to the way in which staff complaints are dealt with – and not just how they are delivered.
“It’s all about improving services and helping to make the trust a good place to work,” Steve explains.
“We have an established grievance procedure in the NHS, but that is quite an adversarial option – you are almost setting one person against another and [it becomes about] who is going to win.
“We want to move towards a focus on resolution, because the research shows that if you can de-escalate things and move to a meaningful conversation amongst individuals, that is a much healthier place to be for both sides.”
Perceived unfair treatment is the most reported issue across the year to date, followed by patient safety concerns in relation to workload and staffing levels.
Staff who come forward can choose to identify themselves to those investigating their complaint - with the assurance that there will be no detriment to the individual for doing so - or remain completely anonymous.
While Steve understands staff reluctance to put their names forward if their concern relates to the behaviour of a colleague, he hopes that a recently-launched campaign at the trust will change that – and make it easier for him to check whether problems have been resolved.
The 7000-strong workforce is being invited to “call it out with compassion” if they see something that makes them feel uncomfortable.
“If someone is behaving in a rude way or a way which somebody perceives as bullying, that person isn’t always aware they’re doing that – so if you can reflect it back to them with compassion, you can be much more influential in changing their behaviour,” Steve says.
“Sometimes people are under pressure and that’s translating into poor behaviour – but there may be no malice there, just a lack of awareness. We should be calling it out, but there’s no need to hit somebody with a sledge hammer – it needs to be a just culture.”
Twenty FTSU ‘champions’ support Steve in his work by being trusted faces to whom concerns can also be taken. Having worked at the hospitals for nearly 30 years – as a nurse and later in corporate governance – he says that every staff member should feel that they have a voice – and that he is not afraid to “speak truth to power” on their behalf.
The FTSU concept in Central Lancashire was developed in the wake of the Francis Inquiry into poor practices and avoidable deaths at the Mid Staffordshire hospital trust. The systems for dealing with staff concerns now form part of the inspection regime for hospitals across the country.
The FTSU team does not investigate the issues brought forward by staff, but can provide a catalyst to start the process.
At a recent LTH board meeting where the revised local policy was approved, the trust’s nursing director welcomed the work of the FTSU Guardian – but was concerned that the role was even necessary.
“It suggests that some of our leaders can’t be approached,” Sarah Cullen said.
“The sign of a healthy department is when it’s within the culture to be able to refer a problem up – rather than go outside the department [to an independent person].”
Workforce director Karen Swindley said that she expects the steadily rising number of FTSU cases to level off – but admits that the initial interest from staff showed that the trust’s previous system for registering concerns had “not been adequate”.
Steve told the meeting: “I’m putting myself on a path to self-redundancy – though I don’t know whether that’s really achievable or not.”
COULD A KINDER APPROACH TO COLLEAGUES SAVE A PATIENT'S LIFE?
A group of medics has prescribed a more pleasant atmosphere in the nation’s hospitals as one route to improving patient care.
The “Civility Saves Lives” campaign has gathered evidence from studies in medical and office settings and found that rudeness comes at a cost.
It is claimed that more than three quarters of those spoken to sharply at work reduce their commitment to the organisation and over a third find that the quality of their work is affected. For patients or their families who witness such exchanges, two thirds lose confidence in the hospital as a result.
At Lancashire Teaching Hospitals, the trust’s Freedom To Speak Up Guardian, Steve O’Brien, agrees with the findings.
“When somebody is rude, [it has] a negative impact on productivity – because the people around them become preoccupied with it. The conclusion is that less effective clinicians provide poorer care and so poor behaviour affects everybody,” he says.
7,000 – approximate number of full-time equivalent staff at Lancashire Teaching Hospitals
75 – number of Freedom To Speak Up cases brought at the trust so far this year
15 – cases involving perceived unfair treatment
12 – cases where staff have been concerned about patient safety because of workload
8 – cases of claimed bullying and harassment