As board members, you will be acutely aware of your responsibilities for oversight of organisational culture, and the impact of culture on performance. Fostering a ‘Speak Up, Listen Up, Follow Up’ environment where workers feel psychologically safe and empowered to speak up, not only supports the wellbeing of workers, but also leads to successful outcomes—whether that is for patients (as in the healthcare sector) or for customers or shareholders (in the private sector).

As the National Guardian for the NHS, my role was established following Sir Robert Francis QC’s inquiry into Freedom to Speak Up in the NHS, and the tragic impact that fear about the consequences of speaking up and lack of confidence that concerns would be addressed had on patients.

Freedom to Speak Up

His recommendations led to a network of Freedom to Speak Up guardians in healthcare organisations in England, so that workers throughout the sector can speak up about anything which gets in the way of delivering great care. Our vision is to improve workplace cultures, ensuring workers are confident to speak up, by providing expert support, guidance and challenge.

The culture of organisations has been shown to impact safety, innovation, learning, performance, motivation, compliance, diversity and inclusion, and workforce well-being. If we do not listen to our workers, we will not reap these wider benefits of an engaged workforce.

Michael West, professor and researcher into organisational effectiveness, says staff engagement is the biggest predictor of organisational performance. An organisation with a healthy, open culture that lives its values will attract and retain the best workers. In a time when talent is at a premium, this is invaluable.

The challenges to fostering a Speak Up culture are not unique to healthcare. Transforming organisational culture begins with the willingness to listen to what workers are saying, and the open mindset to use what is heard to take action and make improvements. But speaking up can only effect change if leaders and managers listen up and follow up. Leaders set the tone from the top.

Negative gains

The National Guardian’s Office conducts reviews into speaking up practices in organisations, and we have found that senior leaders and boards do not always understand the benefits which fostering an open speaking up culture can bring. I hear of board members who focus on the positives and ignore the negatives in speaking up reports, only wanting to hear good news.

I would like to see a shift from a position of ‘comfort seeking’ to curiosity about speaking up, where leaders and board members are inquisitive about what is presented to them and are keen to embrace the learning which listening to those who speak up can bring.

Data can give you insights, but a board’s role is to look behind the numbers, to join the dots. If few people are speaking up, does this mean you should you feel confident that all is well? Or does it indicate a deeper problem of fear and mistrust which should give the board cause to dig deeper?

Triangulate your data—staff survey results, sick days, grievances and silence. Get out and about—no one really understands what is going on in their organisation by listening to pre-prepared briefings in a boardroom. Whether it is walking the wards or the shop floor, talk to your people to understand what a conversation feels like in your organisation.

Be aware that power can silence truth and that senior people are more likely to believe that speaking up in their organisation is easy to do.

The National Guardian’s Office recently published our analysis of the questions relating to speaking up in the NHS Staff Survey (Listening to the silence: What does the Staff Survey tell us about speaking up in the NHS?)

While workers’ confidence in speaking up about anything which concerns them showed signs of improvement, the survey revealed a five-year low in the number of respondents who feel secure raising concerns about unsafe clinical practice.

As the National Guardian, I was disappointed to see this lack of improvement, despite Freedom to Speak Up guardians handling a record number of cases. Guardians offer an alternative way to speak up when workers do not feel able to in other ways.

The importance of trust

The results from the staff survey highlight that their role has never been more important. They are also there when people have tried to speak up but feel that their concern has not been listened to. The increase in cases being handled by guardians may signify that other speaking up routes are not felt to be effective or trusted.

It is essential that boards reflect on what their workers are telling them about “what it is like around here”. That’s not merely taking the headline numbers from staff surveys, but digging deep into the detail. Use all the data and engagement opportunities you can to listen to the silence. Who are you not hearing from? Why are you not hearing from them? Are they fearful, disenfranchised, disillusioned? What more can you be doing?

This is a whole board approach, not just for the non-executive director who is the lead for freedom to speak up or whistleblowers’ champion, or as an agenda item for the audit committee. Listening to and engaging with our workers is key to a productive, high quality and safe workplace. This is why our theme for this year’s Speak Up Month in October is Listen Up. As leaders we should ask ourselves daily: “What have I said today to reinforce the message that anyone’s voice can make a difference and that I want to hear it?”

Jayne Chidgey-Clark is the National Guardian for the NHS.