Abstract
SummaryObjectivesTo examine the experiences of clinical and managerial leaders in the English healthcare system charged with implementing policy goals of openness, particularly in relation to improving employee voice.DesignSemi-structured qualitative interviews.SettingNational Health Service, regulatory and third-sector organisations in England.ParticipantsFifty-one interviewees, including senior leaders in healthcare organisations (38) and policymakers and representatives of other relevant regulatory, legal and third-sector organisations (13).Main outcome measuresNot applicable.ResultsParticipants recognised the limitations of treating the new policies as an exercise in procedural implementation alone and highlighted the need for additional ‘cultural engineering’ to engender change. However, formidable impediments included legacies of historical examples of detriment arising from speaking up, the anxiety arising from increased monitoring and the introduction of a legislative imperative and challenges in identifying areas characterised by a lack of openness and engaging with them to improve employee voice. Beyond healthcare organisations themselves, recent legal cases and examples of ‘blacklisting’ of whistle-blowers served to reinforce the view that giving voice to concerns was a risky endeavour.ConclusionsImplementation of procedural interventions to support openness is challenging but feasible; engineering cultural change is much more daunting, given deep-rooted and pervasive assumptions about what should be said and the consequences of mis-speaking, together with ongoing ambivalences in the organisational environment about the propriety of giving voice to concerns.
Highlights
The insights from the ‘front line’ or ‘sharp end’ of organisations are an important resource for detecting problems, learning and improvement, organisations often struggle to encourage ‘employee voice’ and to respond appropriately.[1]
How to realise a policy commitment to cultural change of the kind necessary to address these barriers remains an important challenge and one that we address in this article? We report findings from a recent interview-based study that sought to examine the experiences of clinical and managerial leaders in the English healthcare system who were charged with implementing the policy goals of openness
We interviewed 18 participants from acute hospitals, 17 from community and mental healthcare trusts (MH), and three from ambulance trusts (Am)
Summary
The insights from the ‘front line’ or ‘sharp end’ of organisations are an important resource for detecting problems, learning and improvement, organisations often struggle to encourage ‘employee voice’ and to respond appropriately.[1]. Voice in the healthcare system has become a prominent focus of government policy.[4,5] In England, this attention has been driven in particular by a high-profile failings in care at Mid Staffordshire NHS Foundation Trust. Led by Sir Robert Francis QC, a public inquiry into events at the hospital,[6] and a more wide-ranging review of Freedom to Speak Up,[7] suggested that voice in healthcare organisations was inhibited by individuals’ fear of repercussions and by perceptions of futility. The government declared its intention to take steps to foster openness, defined in the Francis inquiry as ‘enabling concerns to be raised and disclosed freely without fear, and for questions to be answered’.6
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