Uncovering, creating or constructing problems? Enacting a new role to support staff who raise concerns about quality and safety in the English NHS

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Martin, G. P., Chew, S., & Dixon-Woods, M. (2020). Uncovering, creating or constructing problems? Enacting a new role to support staff who raise concerns about quality and safety in the English National Health Service. Health10.1177/1363459319901296

  • 31 January 2020


Why it matters

Healthcare staff are an important source of information about quality and safety problems. And recent incidents at UK hospitals have shown what can happen when staff don’t voice their concerns.

A 2015 report about speaking up in the NHS following the disaster at Mid Staffordshire concluded that staff knew about the hospital’s safety issues but were reluctant to come forward. To avoid repeating the mistakes of “Mid Staffs”, the report recommended creating a new role at NHS trusts in England to support staff in raising concerns. The “Freedom to Speak Up Guardian” would be an expert in all things related to speaking up and an impartial source of advice.

The role was unprecedented in the UK and internationally. And when it was first implemented in 2016, there was little guidance from government on how Guardians should be appointed, and what their specific responsibilities should be.

This study is the first exploration of how Freedom to Speak Up Guardians have fared thus far. It critically examines the new role while considering broader issues around “employee voice.”

Our approach

To look more closely at Freedom to Speak Up Guardians, we conducted 51 interviews with clinicians, administrators, and others involved in implementing the role. This includes the Guardians themselves, policymakers, and representatives from regulatory bodies and third-sector organisations.

Interviews were conducted between July 2017 and January 2018 as part of a wider mixed-methods research study.

What we found

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