Abstract
Healthcare organisations reap significant benefits when workers’ concerns are adequately listened and responded to, including improved patient safety, reduced costs and improved staff experience. Although many concerns are dealt with satisfactorily, compelling evidence suggests that problems of silence (where employees do not speak up) and deafness (where organisations do not hear concerns or act) remain pervasive worldwide. In the English National Health Service (NHS) the response to these problems includes numerous policy initiatives and the introduction in 2016 of the “Freedom to Speak Up Guardian” (FTSUG) role. This globally unique role is described as potentially leading to huge improvements in the way staff concerns are handled and responded to leading to improvements in organisational learning and patient safety. Following their introduction thousands of NHS staff have already spoken up via FTSUGs. The majority of FTSUGs time is spent on bullying and harassment concerns, rather than direct patient safety concerns, which appears to have confounded FTSUGs’ and others’ expectations. This chapter opens by describing the background to the development of the FTSUG role. We then outline the literature on bullying and harassment; its shocking prevalence within healthcare workplaces and the damaging consequences of bullying borne by organisations and individual staff and patients. We also discuss our analysis of semi-structured interviews (n = 87) undertaken with FTSUGs, which illustrates the realities of dealing with colleagues’ concerns about bullying and harassment and how these realities are often overlooked in national, regional and local workplace guidance and training materials currently available to support the implementation of the role.