Dr Henrietta Hughes OBE, the National Guardian of the NHS explains how the National Guardian’s Office and Freedom to Speak Up Guardians can help those affected by bullying in the NHS.
What is the role of the National Guardian’s Office and Freedom to Speak Up Guardians in tackling bullying?
The Freedom to Speak Up Guardian role was created in response to recommendations made in Sir Robert Francis’ report on the Freedom to Speak Up review, which found that the culture in NHS organisations did not always encourage or support workers to speak up, and that patients and workers suffered as a result.
The National Guardian’s Office (NGO) aims to effect cultural change in the NHS and make speaking up business as usual.
The NGO supports a growing network of nearly 600 Freedom to Speak Up Guardians throughout the health sector who have collectively dealt with over 35,000 issues brought to them by workers.
FTSU Guardians ensure workers can speak up about anything that has an impact on their ability to provide quality patient care, and feel safe and supported when doing so. That includes behavioural issues like bullying.
Workers voices’ form a pillar of the People Plan. Guardians are key in ensuring workers are heard, particularly those groups of workers who are less often heard and who may face barriers to speaking up. Fear of being bullied for speaking up is one of those barriers.
In the Freedom to Speak Up Review, Sir Robert Francis recognised that bullying is often “in the eye of the beholder” and that the term can be misapplied but also that “to an extent, whether people’s experiences meet an objective standard definition of bullying or not is beside the point. If someone believes they have been bullied or harassed and the perception of others around them is that they have suffered or will also suffer in a similar way as a result of speaking up, then they will be less likely to raise a concern in future …. The perception of bullying can have the same detrimental effect as deliberate bullying conduct.”
The NGO collects data from Guardians about the type of cases being brought to them, and one of the questions we ask is whether there is an element of bullying or harassment. Of the 16,199 cases brought to Guardians last year, 36% had an element of bullying or harassment.
How can FTSU Guardians help people who are being bullied at work?
FTSU Guardians provide an alternative channel for people to speak up to, if they feel for whatever reason they can’t speak to a line manager or a supervisor. They listen, and can offer support to help the person escalate the matter. Importantly they will also feedback to the person about how the matter is handled and used for learning.
At the NGO, we’ve been collating stories of people who have spoken to guardians, and you can read some examples of how guardians help, not just the individual, but the organisation to learn from that person’s experience and begin to improve their culture.
I have come across people using accusations of bullying as a form of bullying – how do you manage this in your work?
One of the Freedom to Speak Up Guardian values is impartiality. Guardians listen without judgement. They are there for those who speak up and for those who are being spoken up about.
The challenge when talking about bullying is, as Sir Robert said, it is about perception. Could how I’m behaving be perceived as bullying? Is what I’m asking someone to do aligned with my own and my organisation’s values? Or is there an opportunity to have a conversation, and for mutual learning to take place? It’s worth checking in with yourself as a manager, using a tool like the Vanderbilt model.
What work are you doing (or what changes would you like to see happening) within organisations and senior leadership to tackle bullying? In my experience bullying is rarely dealt with effectively or directly, often leaving the victims no choice but to leave their jobs. If it is dealt with it is usually through a “bad apple” approach meaning that the organisation does not accept accountability for the systemic issues that enable bullying. Do you take a systemic approach in your work?
I would agree that bullying is perceived differently by different people, that the underlying causes can be systemic and that it can impact on delivering high quality care. I’ve heard this described as rotten apples, rotten barrels or rotten orchards.
We know, for example, that incivility in the workplace is a patient safety issue – that 38% of those who experience it say the quality of their work is reduced. And the impact is on the whole team – witnesses to workplace rudeness have a 20% decrease in performance. So, bullying is both a behavioural and a patient safety matter – and there needs to be an organisational response to it.
The Freedom to Speak Guardian role is both reactive and proactive. As well as supporting workers, they work in partnership with other parts of their organisation to identify hotspots of cultural issues and to tackle barriers to speaking up. They present learning and themes to senior leaders, so that the information brought is used for learning and improvement. Alongside data and intelligence, staff stories to Board can be used to engage the senior leadership.
We are helping to develop that holistic approach across the healthcare sector by sharing the FTSU Guardian data with the Model Hospital team, so that speaking up data can be viewed alongside other data points, such as staff absence.
Silence can also be a signifier of a bullying culture. Take a look at where there are pockets of silence within your organisation (for example, who you are not hearing from; who isn’t filling in the staff survey). Guardians work proactively to encourage those whose voices may not be heard, for example by working with their local Workforce Race Equality Standards (WRES) experts and Equality, Diversity and Inclusion leads.
The NGO is a founding member of the AntiBullying Alliance and I commend the resources developed by Royal College of Surgeons of Edinburgh and their #LetsRemoveIt campaign.
Next steps:
If you would like to contact your Freedom to Speak Up Guardian to discuss bullying at work, you can find their details on the NGO website.
