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.tweet this
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:
- have real commitment and enthusiasm for the role. This is more important than which executive portfolio they hold.
- appreciate confidentiality. One of the most delicate situations we face is when another executive director learns of issues raised in their area and requests details so that they can take action. We have to respect their desire to resolve matters and work with them without undue disclosure. Having our lead’s support is key to this and helping us maintain our reputation position at points when it can be challenged.
- contribute suggestions for issue resolution using their experience.
- help us produce appropriate data for the board - information providing insight into the organisation as well as the role’s effectiveness. We all want 'to measure what is important not make important that which is measurable'.
- recognise the risk that our roles are seen as only dealing with problems and distress. Some leads have helped by reinforcing the natural link between the Guardian and organisational development process enabling us to participate in positive initiatives. This provides balance in the roles and helps keep us motivated.
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:
- developing a relationship with their Guardian without of course undermining the executive lead role
- keeping us appropriately sighted on relevant organisational politics and requiring us to develop the micro-political savvy that is essential for us to function effectively.
- giving us feedback on how best to inform and assure our boards.
- modelling the openness and no-blame behaviours underpinning the culture that speak-up seeks to support.
- mediating with demands that come nationally so that our roles don’t become overburdened, blurred or in too much overlap with other functions.
- giving us access to supervisory support and development appropriate to this emerging function
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.Chief executivetweet this
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.