Guarding the Guardians: what can trusts do?

22 January 2020

The authors of this blog are Guardian participants in a supervision group and their supervisor, funded by East London Foundation Trust.

Since 2016, NHS trusts and other organisations have been required to establish a Freedom to Speak up (FTSU) Guardian role appropriate to local conditions.  The role is to ensure that colleagues can speak up about anything that might affect the quality of staff experience or patient care.  But, how can trusts support Guardians to develop cultures where staff are enabled to raise and address issues at an early stage before safety is compromised?  

As a group of Guardians, we have worked together in supervision and research over the last year to identify what helps and hinders effectiveness of Guardians.  Our work contexts are all different. We are full and part time, we have differing line management, professional backgrounds and pay grades and we call on varying levels of support from speak-up ambassadors and champions. Despite this mix, we have found common ground in our experience of the role and what executive directors and CEOs can do to enable it.  The key points from our findings are set out below.

 

The role and its challenges

The Guardian role appeals to people with strong values and a desire to improve healthcare.  The commitment Guardians typically bring can be eroded by the volume and nature of FTSU work, so that we lose sight of the positive impact of our work. Whilst there is guidance on being a Guardian, none of us walked into a job with clear boundaries and a defined remit.  We all work with executive leads to develop our organisation’s approach to the role.  This is good - each organisation is unique - but also challenging since we are relatively junior with limited ability to shape the structures we need.  In addition, the role requires us to work within strict boundaries of confidentiality and yet create change based on our information.  We collect data on issues and concerns for the National Guardians Office but its value to our promotion of cultural change is limited.  That information cannot easily capture how the patterns of concerns emerging relate to our organisations, nor the outcomes of work to address the issues raised and the learning from them.  The lack of clear boundaries means our roles can easily be seen as intruding into HR or health and safety functions.  The role can be isolating and often stressful.  We are the repository for some of the darkest behaviours in an organisation and much of our work addressing those behaviours is demanding emotional labour.

Whilst there is guidance on being a Guardian, none of us walked into a job with clear boundaries and a defined remit. We all work with executive leads to develop our organisation’s approach to the role.

   

 

Whatever structure we work within however, we all recognise the importance of two of our key relationships:  with our executive lead and CEO.  Where these work well the Guardian can be effective.

 

The role of executive lead

In sharing our experiences with each other, we believe that executive leads make a difference when they:

 

The role of CEOs

Some of us have strong relationships with CEOs through which we can communicate rapidly and informally and provide them with early warning of patterns in issues occurring.  CEO's can contribute in conjunction with the executive lead by:

 

We would not have come together for this work without the financial support of East London Foundation Trust (ELFT) in funding this supervision for its own Guardian and colleagues from other trusts.  ELFT CEO, Dr. Navina Evans described her reasoning: "I was pleased to be able to support this work. The Freedom to Speak up guardian is such an important role, towards improving safety and wellbeing for staff and patients. It is a demanding and emotionally draining role, therefore important to have adequately resourced support and to value the ability to learn from one another."

I was pleased to be able to support this work. The Freedom to Speak up guardian is such an important role, towards improving safety and wellbeing for staff and patients. It is a demanding and emotionally draining role, therefore important to have adequately resourced support and to value the ability to learn from one another.

Navina Evans    Chief executive

 

We hope our research will stimulate debate among Guardians, executive leads CEOs and Boards – about how to make the role and practice of FTSU Guardians as beneficial as possible for patients and staff.

 

 

Photo (Left- Right): Adewunmi Dosunmu-East London NHS Foundation Trust, Georgina Charlton- Guys and St Thomas' NHS Foundation Trust, Lizzie Swift- Salisbury NHS Foundation Trust, Anna Spitieri- Barnet, Enfield and Haringey Mental Health Trust, Renata Bruozyte- North East London NHS Foundation Trust, Katy Crichton- London Ambulance Service NHS Trust, Penny Lock- Integrated Development Limited, Liz Lubbock-Central London Community Healthcare NHS Trust.

The group is supervised by Penny Lock, on behalf of Integrated Development Limited.


 Read our press statement here.

 

 

 

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