Ruth Agg and Dominique Holliman, Freedom to Speak Up Guardians
Speaking up is about anything that gets in the way of patient care or that affects your working life.
Speaking up can be offering a suggestion for improvement, raising a concern, or whistleblowing.
The trust has two Freedom to Speak Up Guardians, Dominique Holliman and Ruth Agg. To celebrate Freedom to Speak Up month this October, we speak to our guardians and find out more about the role they play.
“We are part of a team of over 900 guardians employed within NHS trusts, the independent sector and regulators,” says Dominique. “Our roles are impartial and independent, and we are trained by the National Guardian’s Office. We work hard to promote a healthy speak up culture across the trust.”
Ruth continues: “Freedom to Speak Up Guardians help protect patient safety and the quality of care, improve the experience of workers and promote learning and improvement. We support our staff in speaking up and address any barriers that may be in their way to ensure we foster a positive culture of speaking up across the trust.”
The role of Freedom to Speak Up Guardian was established following a report by Sir Robert Francis QC in 2015. The Francis report found that NHS culture did not always encourage or support workers to speak up, and patients and workers suffered as a result. Since his report, the CQC inspect the speaking up culture of all trusts and guardians are key to their review of how ‘well-led’ trusts are.
“We encourage staff to speak up to their line managers in the first instance, as they are well placed to respond,” says Dominique. “Staff tend to approach a guardian when they feel unable to use the normal reporting routes, or they do not feel that their feedback or concern has been appropriately heard or responded to.
“Any member of staff can approach us to discuss their concerns or to give feedback and make suggestions for improvement,” she continues. “This includes former staff, volunteers and students. We support individuals to feel heard and, if necessary, to share and escalate concerns to ensure the safety and wellbeing of our staff and patients.”
Ruth was the trust’s first Freedom to Speak Up Guardian, taking up the post in 2016 following a career as a nurse.
“I have always been passionate about high quality care and I am proud to be a registered nurse,” says Ruth. “As I moved into leadership I sought opportunities to raise concerns and look at changes in practice that could support improved patient care and safety.”
Dominique joined the team in 2020, following a career in nursing, health visiting and as a nurse prescriber.
“I have always been a strong advocate for supporting staff and enabling them to deliver the highest standards of care,” she says. “Before taking up this post, I spent over two years as an occupational health nurse, which cemented my desire to work closely with our workforce.
“This role allows me to meet staff across all disciplines and to ensure that our trust is listening and acting on anything that gets in the way of patient care or affects working life. I feel privileged to be contributing to a culture which upholds safety, trust, professionalism and integrity.”
A culture in which workers feel safe and can confidently share their voice and speak up plays a critical role in organisational effectiveness. The trust wants staff to see that their opinions matter and that what they say is valued and acted upon.
“Staff are more committed and we see performance and retention improve when they feel their voices are heard,” says Dominique. “Feedback presents an opportunity to drive improvement and we know that when workers feel safe to highlight issues, they are better able to innovate, perform well and provide ever safer, more effective care.”
“When things go wrong, we need to make sure that lessons are learnt, and things are improved,” says Ruth. “If we think something might go wrong, it’s important that we all feel able to speak up to stop potential harm.”
“Staff who come to us usually want to discuss an issue that feels unresolved. The reasons can vary greatly,” Dominique continues. “The majority of feedback relates to systems and processes – perhaps where staff have identified that these could be improved upon.
“Incivility in the workplace is a common concern and we know the detrimental impact it has, not only upon wellbeing but also for patient and staff safety and productivity. Staff come to us with concerns about inappropriate attitudes or behaviours.
“Other areas for feedback include perceptions of discrimination, bullying and harassment or staff safety and wellbeing. We also hear from staff about areas of their work environment or conditions that could be improved upon. No two days are the same.
“Guardians cannot promise to achieve resolution, but we always commit to listen, to check on the wellbeing of the individual and to thank them for sharing their feedback.”
Our guardians work to make speaking up part of business as usual, one where information raised supports learning and benefits the wider staff culture. Ruth and Dominique can signpost individuals to other services or help them to escalate their concerns themselves.
“There are ‘quick wins’ where sharing feedback and alerting line managers results in a change of process or circumstance that quickly provides assurance,” says Dominique. “Other issues can take longer for the circumstances to be fully explored, for us to understand any risks involved and what action might need to be taken.
“Some of the most satisfying changes involve working with individuals who have initially approached us in a state of emotional distress or with extreme concern and we have been able to confidentially support their wellbeing, address the issue and provide assurance of a satisfactory outcome.
“I am really proud that recent survey results identified that 98% of our staff had a positive speaking up experience with a guardian and would speak up again.”
Staff can find out more about speaking up by searching ‘Freedom to Speak Up’ on the extranet.