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RAISING CONCERNS: Outline presentation
Today’s presentation
• What is raising concerns
• Raising concerns post Francis
• Our organisation’s policy
• Our challenges and gaps
• How to influence culture change
• Why we need board or other appropriate governance structure buy in
• Tips and resources
The need for culture change
The Francis Inquiry and subsequent reports including the Freedom to Speak Up
review have reinforced the need for organisational culture change. Organisations
need to:
• Assess progress in creating and maintaining a culture of safety and learning,
ensuring the culture is free from bullying
• Encourage regular reflective practice, individually and in teams
• Have policies and procedures built on good practice
• Talk about and publicly celebrate raising concerns
• Ensure staff have formal and informal access to senior leaders
Raising concerns is not exclusive
to the NHS
Clapham rail crash - an inspector failed to report loose
wiring because ‘he didn’t want to rock the boat’.
Zeebrugge Ferry tragedy - it had emerged that staff on five occasions
had raised concerns that ferries were sailing with their bow
doors open.
Collapse of Barings Bank - it was found a senior manager
had failed to blow the whistle loudly or clearly.
Progress v challenges
Many employers
are actively
working to
improve staff
confidence to
raise concerns
Workforce
challenges impact on
staff motivation and
confidence
Historical negative
perceptions
Lack of clarity
National staff survey trends –
where are we?
Percentage of staff who strongly
agree/agree
2012 (101,169 total
2013 (203,000 total
2014 (255,000 total responses)
responses)
responses)
Staff know how to report
concerns about fraud,
malpractice or wrongdoing
90%
90%
93%
Staff who feel safe/secure to
report a concern
72%
72%
68%
Staff who would feel
confident their organisation
would address the concern
55%
56%
57%
Our statistics
• Use this slide to insert local staff and patient experience surveys or other relevant
information available to you
ACTION! SPARE SLIDE FOR YOUR INFORMATION
Importance of getting it right
Right
Wrong
 Increased patient safety
x
Harm to patients and staff
 Good organisational reputation
x
Poor organisational reputation
 Financial savings
x
Financial implications
 Organisational wide awareness and open culture
x
Lack of staff awareness
 Increase in morale, productivity and positive staff survey
results
x
Low staff morale, productivity and staff survey results
 Stakeholder and regulator confidence in good
governance
x
Regulatory response/Crisis management
 Lower rates of sickness absence and stress
x
x
Increased sickness absence and stress
Poor working relationships
 Staff feel supported and valued
x
Reduced productivity
 Low turnover
x
High turnover
Benefits for patients
and staff
Supportive, open and
transparent culture
Improved patient care –
better experiences
Reduction in incidents – early
prevention
Confident and empowered
staff – improved morale
Improved staff engagement –
improved productivity & lower
sickness levels
Our raising concerns policy
ACTION! SPARE SLIDE FOR YOUR INFORMATION
Use this slide to outline your organisation’s current position. For example:
• When was the raising concerns policy last updated?
• Who has responsibility for championing raising concerns?
• How do we communicate with and engage our staff
o Any promotional materials?
o Regular channels (intranet, posters, etc.)
Our challenges and gaps
• Use this slide to outline your organisation’s challenges and highlight any
gaps
ACTION! SPARE SLIDE FOR YOUR INFORMATION
Drivers for positive culture change
 Robust communications and staff engagement
 Strong organisational values: embedded through values based recruitment, induction and appraisal
 Clear understanding of all supporting policies and procedures
 Clarity – understanding the difference between a concern or a grievance
 Openness and transparency
 Early intervention
 Effective training for managers
 Appointing a freedom to speak up guardian to act as a local ambassador to ensure concerns are dealt with appropriately and effectively
 Nominating an executive director and non-executive director within your organisation to receive the concerns
 Nominating a manager in each department to receive the concerns
 Staff are given access to information and know where to find advice and support from external sources (for example, the national
Whistleblowing Helpline and Public Concern at Work)
All need board or other appropriate governance support.
Influence culture change
 Know how to deal with a concern
 Embedding values and leading by example
 Be visible to staff
 Continually improve policies and mechanisms for reporting concerns
 Ensure managers are trained and supported to deal with concerns,
difficult conversations and any associated emotional impact
 Ensure feedback is provided
Raising concerns guardians,
ambassadors or champions
Benefits:
Champions can help
ensure raising concerns:
 Raise awareness amongst staff
 Instil confidence that concerns will be listened to and
addressed
 Offer staff an alternative reporting route to their line
manager
 Help ensure the voice of staff is heard at a senior level
 Provide feedback at senior level to ensure constant
development of policies and procedures
Are regularly
reported on
and
discussed at
board level
Become
embedded in
your staff
engagement
strategy
Contributes
to the safety
and quality
of patient
care
Are seen as a
normal part of
employment
Tips from other organisations
 Make raising concerns an integral part of your staff engagement strategy
 Encourage openness and transparency
 Think about implementing a tool, model or forum which allows all staff to report
genuine concerns directly to the chief executive or senior management
 Recruit an ambassador for cultural change who autonomously reports directly to
the senior management team
 Develop and support a network of raising concerns guardians, ambassadors, and
champions
 Work with staff and provide appropriate training
 Use the tools and resources available to promote raising concerns
Information, tools and resources
 Legislation and policy
 Draw the line logo, assessment tool, manager’s guide, presentation and how to use guide
 Values based recruitment mapping tool – map your organisational values to that of the NHS Constitution
 Model process flow chart – raise awareness
 Raising concerns at work: Whistleblowing Guidance for Worker and Employers in Health and Social Care – guidance for you
and your staff
 National Whistleblowing Helpline – free confidential advice for all health and social care staff
 Public Concern at Work – helps you give staff confidence to speak up early
 Raising concerns posters – help raise awareness
 Ten top tips for reporting concerns – can be used a pay slip insert or posted on your staff intranet
 NHS Employers Staff Engagement Toolkit – improve staff engagement
 NHS Employers DoOD toolkit – ensure your staff are working as a team, towards a common culture
 List of prescribed bodies where concerns can be escalated
 Frequently asked questions
5 Boroughs Partnership NHS Foundation
Trust has committed to taking a transparent
approach with patients, carers and staff as
demonstrated in its ‘Let’s Talk’ initiative. Read
more about the success of their ‘afternoon
with the chief executive’ sessions and
transparency in the trust. Read the case
study.
Read how Staffordshire and Stoke On Trent
Partnership NHS Trust have created an open
and transparent environment to ensure that
individuals have the support they need when
they raise a concern. Read the case study.
Learn from
others
success…
East London NHS Foundation Trust have
developed a framework for listening which
aims to support culture change. Dr Amar
Shah, Quality Improvement Lead &
Consultant Forensic Psychiatrist at the trust
shares their ideas. Read the case study.
Birmingham and Solihull Mental Health NHS
Foundation Trust thinks it is important that
all staff have a number of mechanisms to
raise their concerns early, and anonymously
if they prefer. Find out about ‘Dear John’ an
informal tool devised and implemented to
enable staff to raise their concerns. Read the
case study.
Gateway number 02948