Modelos de medición de la Calidad del Servicio

A trust has established a new role which they have called an ‘Ambassador for Cultural Change’.

The post was established in response to the very low usage by staff of an external advice line for those considering raising concerns. The trust knew that it had to do something differently to encourage people to speak up.

The purpose of the role is to support and help drive a programme of change in the trust so that it becomes an open and supportive place to work. The Ambassador works independently and reports directly to the Chief Executive on a very broad range of matters that staff bring to her attention, such as safety, quality, welfare and process. Importantly, if she doesn’t think that the trust is living up to its values, she is able to hold them to account. She supports staff in raising concerns, offers reassurance to those reluctant to speak up, helps develop training and works across organisational boundaries to make the trust a safer place to be treated and a more open place to work. Since taking up the post, the number of incidents that have been reported and concerns that have been raised has increased dramatically.

7.2.12 A role of this nature in another trust has a wider remit that also includes patient complaints.

7.2.13 A role such as this can have a number of advantages. It:

• establishes at least one contact to whom staff could go for advice and support if they had a concern or thought their concern was being ignored

• demonstrates a commitment by an organisation to listen to their staff and treat them fairly

• offers a route to raise concerns that is outside of direct line management and HR structures, but with access to senior management, including both executive and non-executive board members, who can take appropriate action if needed

• is seen as independent, impartial and objective

• is someone who could ‘tell it straight, have open and honest conversations and keep the temperature down’ and act as a conduit between staff, senior managers and the board.

7.2.14 There was some discussion about both the title of this role and the job description. On the one hand there is a case for leaving it to each organisation to decide what works for them. However a stronger case can be made for some standardisation.

7.2.15 I am persuaded that there would be advantages to the creation of a local ‘champion’ role in every NHS organisation or group of organisations. Consistency over at least the name would mean that staff who moved between different establishments would always know where to go for support. I have considered a number of potential names for this role including Safety or Speaking Up Advisor/Champion/ Guardian/Ambassador, Openness Advocate and Whistleblower/Raising Concerns Support Officer. What name is chosen matters less than a shared understanding of what it signifies. The role I envisage bears some, although not complete comparison to the well-established function of the Caldicott Guardians. Accordingly my tentative view is that an appropriate name would be Freedom to Speak Up Guardian.

7.2.16 A network of these postholders should be established for peer support, to share learning and identify trends across NHS organisations that might need to be shared with the National Reporting and Learning System (NRLS), CQC or others.

7.2.17 For this to work effectively the postholder needs to have the right interpersonal skills, courage, tenacity, and the respect of colleagues as well as the full confidence of the CEO. The postholder also needs to be pragmatic, fair and understand the structure of his/her organisation and its place in the healthcare system nationally.

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7.2.18 Not everyone will want to approach a Freedom to Speak Up Guardian. It is important to have alternative routes available. For example, someone might prefer to speak to their head of profession or departmental lead. It is best that there are a range of people whom staff can approach all working to the same objectives, and who can work together to ensure consistency of approach across their organisation.

A designated board lead (executive and non-executive)

7.2.19 Some organisations may already have a designated board lead, who may be either an executive or a non-executive director (NED) with specific responsibility for whistleblowing. They may even have both. The general view was that this should be an oversight role, demonstrating the commitment of the board as a whole to effective handling of concerns raised by staff.

7.2.20 It would not be practicable for a NED to act as a sole point of contact for whistleblowers in an organisation, given the time constraints inherent in the role. However, it would be desirable to use a NED’s ability to act as an independent voice and board level champion for those who raise concerns. The NED would work closely with the Freedom to Speak Up Guardian and, like them, could act as a conduit through which information is shared between staff and the board. The NED should be expected to provide challenge alongside the Freedom to Speak Up Guardian to the executive team on areas specific to raising concerns and the culture in the organisation. When an issue is raised that is not being addressed, they should ask why.

7.2.21 The executive board lead, or leads, would oversee internal processes and keep them under review, ensure staff felt empowered to raise concerns, ensure learning from concerns was shared across the organisation, and should be

accountable for the treatment of whistleblowers within the organisation. They should have the executive responsibility to account to the board, for the system of handling concerns and supporting those who raise them. I suggested in 5.3 that this responsibility should sit with the person responsible for safety and quality, rather than HR.

7.2.22 An organisation might alternatively choose to nominate a range of directors, to enable staff to go to their professional lead or the leader with direct oversight of a particular area. The case study in 6.2.7 describes an organisation in which a panel of executive directors meets weekly to review all concerns to make decisions on the appropriate level of action and to report to the CEO. Such arrangements appear to be highly effective. Again the key is for the board and CEO to establish arrangements that work both for the organisation and for staff within it to create a culture in which people feel supported.

Other leads

7.2.23 For some people an executive or non- executive director may feel too senior to approach. There were suggestions that staff should be able to raise concerns with:

• a nominated manager in each department – some contributors thought it would be easiest for staff to speak to a manager in their own department who was not their line manager; but they also wanted access to someone in another department if for any reason they felt unable to speak to their own nominated manager

• an independent external organisation such as a helpline or advisory service. As shown in 3.2 our staff surveys did not indicate that external helplines are a key source of advice for staff but they clearly do have a role to play. These should be given parity with internal mechanisms in internal whistleblowing policies.

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Case study: The Whistleblowing