Project title

Exploring how healthcare middle managers experience and manage the speaking-up process, and the impact on their wellbeing

Country

UK

Background

This project aims to enhance the ‘speaking-up’ process – a process that is crucial to patient care, patient safety, and staff wellbeing. ‘Speaking-up’ is defined by the National Guardian’s Office, as ‘communicating anything that hinders patient care and patient safety (eg, unsafe practice), or that affects staff wellbeing (eg, bullying and harassment)’. When staff do not speak up, or their concerns are not followed up, the financial implications on patient safety and staff morale, wellbeing, and retention are substantial.

Previous research on speaking-up has only focused on lower-level staff and senior managers, and as a result, little is known about how middle managers experience frontline healthcare staff approaching them with a concern, how they decide to respond, what enables or hinders them to follow up, and how the process might affect their wellbeing.

This project focuses on middle managers who manage frontline healthcare staff, aiming to expand our knowledge about how middle managers experience and manage the speaking-up process and develop practical recommendations for improving the process.

Summary

The project follows a four-phase, exploratory sequential mixed methods design, providing both depth and breadth, where each phase informs the next.

We will use a collaborative approach, working closely with an advisory group throughout the project, to enhance the validity and relevance of the findings and recommendations. Members of the advisory group will include frontline healthcare staff, middle managers, senior managers, Freedom to Speak Up Guardians and Wellbeing Guardians, representatives of the National Guardian’s Office and Healthwatch, along with policy makers.

Phase 1:

A systematic review to collate the evidence given by healthcare professionals of their experience and management of speaking-up globally.

Phase 2:

One-to-one semi-structured interviews with middle managers and stakeholders (ie, frontline healthcare staff, senior managers, Freedom to Speak Up Guardians, and Wellbeing Guardians).

Phase 3:

An anonymous online questionnaire for middle managers, providing opportunities to collect information from a larger population.

Phase 4:

Validating the findings and developing recommendations alongside the advisory group.

Outcome

The project will provide new insights into the unique experiences and complexities of middle managers' roles in the speaking-up process. It will look at how they navigate this process, the decisions they make along the way, and the impact it has on their wellbeing. We aim to identify best practices and key challenges, and understand what support or changes are needed – or that would be most beneficial – across four levels: the individual, then team, the hospital, and policy.