Give everyone a voice

Written by Vicky Burman on . Posted in Communication planning, Talking care

I’ve just had an article published on a website focusing on health and social care reform. The gist of my piece is that any organisation can benefit from making an effort to listen to what its staff have to say.

The other side of the coin is the negative impact of then ignoring not just any concerns they may raise, particularly about quality of care, but their ideas and thoughts on how practices and systems could be improved.

Not only may you miss out on some extremely useful insight and realistic suggestions for change for the better, but by not taking on board what frontline practitioners in particular have to say, or perhaps taking some action as a result but not letting them know that you’ve done so, gives out very negative messages about the perceived value of their opinions and, implicitly, their skills, knowledge and the work they do.

This is clearly not good for employee relations generally, engagement or motivation. And if you do not show willing to take their views seriously, it could lead to a situation where, should they have major concerns, they may see only two options – keeping their worries to themselves or waiting and taking more extreme ‘whistle-blowing’ action at a stage when it is harder to find a rapid and effective solution. 

One of the barriers to delivering high quality care identified by Professor Bruce Keogh’s review was the “limited understanding of how important and how simple it can be to genuinely listen to the views of patients and staff and engage them in how to improve services”.

He was particularly concerned that organisations were missing out on learning from the experiences of junior doctors and student nurses, who not only deal constantly with patients but have the advantage of being able to compare practices in different places as they move around during their training.

They are therefore in an excellent position to see what a particular hospital, department or ward does well and where things could be improved. To not encourage them to voice their opinions is a mistake, says Prof Keogh, who reports that in some trusts the review team visited “junior doctors are not included in mortality and morbidity meetings because they were considered ‘not adult enough’ to be involved in the conversations”. On a personal level that is probably upsetting; on a professional level it is likely to affect the individual’s confidence and interest in sharing learning and innovation.

But even when staff are given a voice, they must feel free to speak openly, whatever their position. Based on its own experience of holding focus groups, the Keogh review concluded that such groups “should avoid mixing staff across different grades. In the small number of cases where this happened, the presence of more senior staff … made staff in lower grades less willing to speak out, or to be truly honest. Similarly, focus groups should not mix professions, as often views from medical staff ‘drowned out’ views from others.”

The fact that this happened, that senior staff made colleagues nervous of voicing their own opinions rather than actively encouraging them to contribute, also says something about the culture of those trusts that may be reflected in their  communication policy and practices.