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Learning, Knowing, Doing Seminar Series: Advocates, coordinators or detectives? The implementation of the ‘Freedom to Speak Up Guardian’ role in NHS organisations (Professor Graham Martin, THIS Institute, University of Cambridge)

Part of the PenCLAHRC Learning, Knowing, Doing Seminar Series. Presentations from previous seminars are available here:

Event details


Employee voice is an important source of organizational intelligence about possible problems in service quality and patient safety, but effective systems for encouraging and supporting those who seek to speak up have remained elusive. A recent innovation in the English National Health Service to encourage voice takes the form of a novel organisational role: the Freedom to Speak Up Guardian. Intended to provide guidance and support for individuals with concerns and nurture cultural change about the importance of speaking up, the role has attracted significant investment—but is as yet unevaluated. We aim to address this gap, and to derive formative lessons for other health systems seeking to foster voice. Our data are drawn from 51 interviews covering the acute hospital, mental health, community care and ambulance sectors of the English NHS, as well as wider stakeholders and commentators, including individuals occupying the Guardian role and those involved in developing, implementing and managing it. We find that for managers, and particularly Guardians themselves, there are challenges in implementing the role in the way envisaged in policy. Many managers were keen to ensure that it focused on clearly defined problems of quality and safety. Those in Guardian roles, however, reported that the role was difficult to delimit so tightly. Colleagues approached them with more wide-ranging concerns that were nascent or difficult-to-articulate. Some concerns were not, on the face of it, obviously quality- or safety-related, but they nevertheless required careful interrogation—and could yield important insights into their organizations. Our analysis suggests that the focus—and, potentially, the principal value—of roles of this kind may be less in supporting and protecting whistleblowers in demanding a response to allegations of wrongdoing, and more in helping those with lower-level worries to make sense of their concerns and what to do with them.

Please note that this seminar may be recorded

Professor Graham Martin

Graham Martin is Director of Research for THIS Institute, a new unit funded by the Health Foundation at the University of Cambridge to develop the evidence base for and impact of work to improve healthcare quality and safety, and Professor of Health Organisation and Policy in the SAPPHIRE Group, University of Leicester. His research focuses on social, organisational and professional issues in healthcare system change, with a particular focus on quality improvement work and policy initiatives to address quality, safety and risk in the NHS.


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