Embedding a healthy speaking up culture

Top tips on how to create a workplace speaking up culture which supports health and wellbeing.

13 June 2023

In this article, we’ve outlined ways that leaders and line managers can work to develop a speaking up culture which also supports staff health and wellbeing. We also highlight  emergent practice from NHS trusts already making these links across speaking up and wellbeing, as part of wider work to improve workplace culture.

To make the NHS the best place to work and a modern employer of choice, we want staff to feel safe and confident to speak up, knowing their voice counts. Having a speaking up and listening culture is critical to supporting an open dialogue, including time for reflection and learning when things go wrong. This drives improvement and can lead to better outcomes for staff and patients.

For workers to speak up, they need to feel safe, respected, included and assured they will not be discriminated against. They also need to feel supported, looked after and cared for. So working to foster a speaking up culture should form part of your wider efforts to embed a compassionate, healthy environment that supports workforce wellbeing.

We know speaking up is not always easy, so creating an environment where staff feel safe to speak up - and confident that action will be taken - will help them feel psychologically safe and able to bring their whole selves to work. It will also help staff feel to be open and honest during conversations about their health and wellbeing, which in turn will help to retain a healthy and happy workforce. 


Top tips for leaders

Compassionate leadership is the foundation for psychological safety and has a profound impact on the wellbeing of teams, organisations and systems. You can embody compassionate leadership by attending to, understanding, empathising with and helping those you lead. 

When you foster compassionate leadership, a just and learning culture can also embedded, creating an environment where speaking up can thrive when things go wrong because it is normal, everyday practice.

Ways you can embed a healthy speaking up culture:

  • Listen and respond with curiosity rather than defensiveness. As leaders, it’s important to embody positive cultural changes and wellbeing practices.
  • Demonstrate that every voice matters. Speak up yourself, encourage others to speak up and show you value speaking up as an opportunity to improve.
  • Level up line managers to support staff to feel safe. Ensure everyone feels able to raise concerns and line managers feel able to support and signpost staff.
  • Encourage wellbeing and speaking up teams to work collaboratively, creating an aligned strategy to embed a healthy speaking up culture.
  • Measure the impact of change, share the learning with your teams and ask for feedback and opinions.
  • Publicly acknowledge mistakes. Being open and honest with staff will encourage them to do the same and will promote a just and learning culture.
  • Acknowledge that people face barriers to speaking up, understand where they exist, who they affect and develop actions to reduce them.


Top tips for line managers

Managers play a vital role in supporting senior leaders to set the right cultural tone for speaking up and handling speaking-up matters effectively.

Ways you can embed a healthy speaking up culture:

  • Take training opportunities on listening, so staff feel heard and appreciated when speaking up. Thank workers who speak up and encourage curiosity about the status quo.
  • Know who to signpost to. Find the avenues of support you can signpost staff to when seeking psychological or wellbeing support or to raise a concern. Invite your health and wellbeing champion or freedom to speak up (FTSU) guardian to a team huddle.
  • Be aware of the barriers people may have when speaking up, including psychological safety and wellbeing. Gain an understanding of what these barriers may be and ways to overcome them.
  • Shift the focus from who has spoken up to what is being said. Ask what can be learnt and acknowledge, if necessary, what has gone wrong. Move away from a blame culture and adopt a just and learning culture.
  • Be a positive role model, if you have concerns of your own, speak up.
  • Encourage team members to speak up in daily working life, including team meetings, supervisions and informal chats. Remind them speaking up doesn’t have to be a formal process. 
  • Be mindful that some staff may not want to speak up to their line manager and this is not necessarily a reflection on you. Make sure your team knows who they can speak up to and share contact details.
  • York and Scarborough Teaching Hospitals NHS Foundation Trust

    The FTSU guardian and health and wellbeing lead work in partnership to develop a culture of compassion and wellbeing. They signpost staff to both health and wellbeing and FTSU services, including how to contact them, what each service delivers and how they can assist staff to feel supported in the workplace.

    Nottinghamshire Healthcare NHS Trust

    FTSU guardians and the health and wellbeing service, including health and wellbeing champions, work collaboratively to engage with staff and deliver team sessions, engagement roadshows and individual support across the trust. These engagement opportunities raise awareness of the broad support available and encourage staff to listen and to speak up. 

    Sherwood Forest Hospitals NHS Trust

    The trust has established a Looking after and belonging sub cabinet. This sub cabinet includes equality and diversity, wellbeing and FTSU leads and works together to deliver support to colleagues. The wellbeing leads periodically attend FTSU champion meetings to ensure their wellbeing needs are being met and they know where to signpost colleagues, if appropriate. The FTSU champions can refer directly to wellbeing services and visa versa.

    Norfolk Community and Health and Care NHS Trust

    FTSU guardians attend monthly wellbeing team meetings and share any insights. The trust recently launched wellbeing training for leaders as well as FTSU guardians to attend, as part of efforts to support and offer dedicated time for leaders to approach wellbeing for any conversations needed.