How can communicators create a better listening climate in the NHS?

Listening is more than the act of hearing. It’s creating an environment in which the other person feels heard.[i]   

According to author and business leadership speaker, Simon Sinek, if we truly listen to someone else’s perspective, we can gain greater understanding and engage in more meaningful dialogue.  It replaces judgement with curiosity. It creates a safe space. 

The question is: how can it be achieved in large organisations like the NHS?  

The NHS is England’s largest employer, with 1.4 million staff, of which 37,381 are managers.[ii]  As an organisation, it hits the headlines every week and the latest was not good news, when on 24 March 2024, it was widely reported that public satisfaction in the NHS has hit an all-time low of 24%.[iii]

A voice that counts? 

Less than three weeks earlier, the annual NHS staff survey was published [iv]. Completed by more than 600,000 employees, NHS England proudly announced positive improvement across most measures, especially those linked to the pledges of the NHS People Promise [v] – namely recognition and reward, learning and development, flexible working and team working. Staff morale also improved, albeit from the lowest base. Notably, there was no improvement around compassionate and inclusive leadership, having a voice that counts, and staff engagement.   

The King’s Fund was less enthused [vi]. Sarah Woolnough, its Chief Executive commented: “While there are some positive improvements across various indicators, we can’t ignore the main message from this survey: that NHS staff are feeling undervalued, stretched and unwell, and there is still work to do to make health and care a more attractive career.”  

Senior leaders within NHS Trusts have the ability to affect change around compassionate and inclusive leadership, voices that count, and staff engagement yet, curiously, these are the areas cited in the staff survey that showed no improvement. So what’s the issue here?  Why aren’t employees engaged, and why aren’t leaders inclusive?  

Freedom to speak up 

Perhaps employees are choosing not to speak up in the first place.  Or if they are, they’re not getting heard.  

The NHS introduced the Freedom to Speak Up initiative in 2015 when a review by Sir Robert Francis highlighted the importance of NHS employees being able to raise concerns in their place of work and to do so safely without fear of reprisals.   

Of course, this has seen some successes, but in the BMJ article “Speaking truth to power: why leaders cannot hear what they need to hear”, [vii] Megan Reitz raises an important point that the focus of Freedom to Speak Up is placed too much on those who feel silenced, urging them to be brave, speak up and have the courageous conversations that are required. She suggests that this approach is not necessarily the way to go. Rather than trying to ‘fix the silenced’, she suggests that Trusts should ‘fix the system’ by placing more time and resources on enabling those who are in perceived positions of power – our leaders – to ‘skilfully invite those silenced to speak and then in turn to listen up themselves’.   

The Art of Good Listening 

So what is listening and why is it an art? 

Dr Kevin Ruck highlights four categories of listening: Passive, Active, Sensitive and Deep [viii].   In short, these categories sit on axes depending on how engaged the listening is. At one end, an organisation or leader remains rational; they hear what’s being said, or read the data but do little with it.  At the other, a deep listener will get to the crux of the matter; they will search for meaning and emotion behind the words and numbers, and they seek to resolve conflict and co-create strategies. 

Most organisations think they listen well but, in reality, Ruck’s research suggests that they sit somewhere between passive and active listening. This is also highly reflective of most NHS Trusts.  

The art of listening requires leaders to understand how to listen and embrace meaningful dialogue. They must see different points of view, lose any unconscious bias and reach out to a diverse audience with curiosity. And, specifically, it’s critical that they override an instinctiveness, and likely well-developed habit, of nodding their heads and making counter arguments.  This is pure lip service to the art of listening, and employees will react with cynicism. 

Pounsford [ix] identifies three common principles that constitutes good listening: openness, responsiveness and empathy. This means a desire to really want to learn from employees and a willingness to listen openly.  Responsiveness in a good leader goes well beyond “you said, we did”.  It is the way in which leaders truly consider what’s said and take action in a way that employees know that their voice was heard, and their thoughts and comments have been considered in the decision making process.  Empathic leaders are those who are visible and approachable, and not just checking survey results from behind their desks. They have a self-awareness that part of their role is to be a good listener, they take the time to go out on to the front line and into the business teams, and they listen to what staff have to say.  

Macnamara has identified sevens ‘canons’ of listening [x] that enable leaders to listen openly, ethically and effectively.  He suggests that they recognise the voices of those who have a legitimate right to speak; acknowledge that they’ve been heard, give enough attention to what’s being said and interpret it fairly in order to understand differing views and perspectives. Only then can leaders give due consideration to what’s been said (whether they agree or not) and provide a substantial response.  

Whilst this approach might not look easy at first glance, it will give employees a true voice in a safe environment.  In turn, authentic listening gives organisations the insight they need to make better decisions, improve business performance and create great places to work. As Tom Peters (In Search for Excellence) says: “The most significant strategic strength that an organisation can have is not a good strategic plan, but a commitment to strategic listening on the part of every member of the organisation”.[xi]  

Good Listening in the NHS 

NHS England wants employees to have a voice that counts. That’s why it conducts its comprehensive annual survey. True, the trend data runs very deep, down to individual Trusts, but senior leaders would be foolhardy to think that’s the tick in the box for staff engagement complete. It simply doesn’t help Trusts learn from each other. 

This year however, CEOs from the top four performing NHS Trusts in England – this year’s NHS staff survey league leaders – did share their thoughts in the recent podcast, Leadership and Culture in Healthcarexii.  Interestingly, none of them chases the NHS Staff Survey outcomes. Each takes the long view, understanding that any knee jerk spot fixes that are highlighted won’t have much impact overall. All four also agreed that they, themselves, are the catalysts for culture change within the organisation. Being highly visible, willing to deep listen to employees and walk the talk in terms of their Trust’s values were the keys to developing a healthy organisation – even before any business strategy is developed and rolled out.  As one put it, on that point alone: “Culture will always eat strategy for breakfast”. 

The Oxleas NHS Foundation Trust is another top performer in the NHS field.xiii As well as being voted Health Service Journal’s Trust of the Year 2023, the Trust also topped the NHS employee survey table in terms of staff feeling involved.   

One reason for this, is its standout initiative called the “Shadow Executive”.[xiv]  For a 12-month rotation, 12 employees of the Oxleas Trust, from all levels, professions and roles, are elected to work alongside the executive team. They feedback on executive meeting papers, share experiences and knowledge of day-to-day work on the front line, and report on well-being at work, and employer/employee relations.  In so doing, they bring a fresh perspective and original thinking to the boardroom because the shadow executive is able to amplify the voices of under-represented staff. The outcomes have been outstanding – benefitting both the organisation and participants.  

Helping NHS Leaders to Listen 

The leadership team at Oxleas has undoubtedly found a clever format to listen better within their organisation. But how else can NHS leaders create a healthier listening climate?  Enlisting the Trust’s communication team would be a good start.   

The pandemic showcased just how important the role of communication is to any organisation and how quickly it changed.[xv] Suddenly, everything went online and the wellbeing of employees very much came to the fore. Listening became critical as organisations grappled with new processes and systems. Digital and social media also became far more prevalent, and this has given communication teams the opportunity to champion listening and dialogue first hand with employees. 

Yet, there is more that NHS communicators can do strategically to oversee listening processes within Trusts.  To get leaders to value listening from the outset, they must align and plan their activities to the organisation’s strategic goals.  

Internal communicators should also be able to influence the listening capabilities of the CEO. As an advisor and coach, they can create opportunities for leaders to be more open, empathic and responsive.  While there’s a wealth of senior leadership support in the NHS [xvi], there’s little evidence to suggest they are taught to listen effectively – only that they should. Getting out and about, being visible and listening to staff in their own environment rather than on screen, behind a desk, is the way for leaders to build trust and to find a common ground with colleagues. Communicators should give leaders the confidence to step outside of their comfort zone, to coach them to listen well and remind them that it’s okay to say “I don’t know”.[xvii] 

Internal communicators could also become the voice of the people. Employee voice and listening feature heavily on the Institute of Internal Communication Profession Map [xviii] and they have the core capabilities to capture what’s unsaid, and to be the conscience of a Trust.  Listening is 95% keeping an ear to the ground – and internal communicators are well placed to use social and digital communication channels, such as pulse surveys and feedback comments to social posts. From here, they can actively analyse data, make leadership aware of the needs and concerns of employees, set the priorities and feedback on actions.   

A brighter outlook? 

If NHS leaders can embrace a deep listening mindset for their organisation, it faces a brighter future. They must first have the courage to hold up a mirror, take stock, and call in their communication team for help.  Listen without prejudice, be curious not judgemental, be visible, and show empathy.  They will soon reap the rewards of new ideas from valued employees, better productivity and performance, and major talent choosing not to move on.   

References

[i] https://www.youtube.com/watch?v=qpnNsSyDw-g (Simon Sinek, the Art of Listening, 2022) (Accessed 20 March 2024)

[ii] https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/nhs-workforce-nutshell#:~:text=18%20December%202023,Workforce%20by%20staff%20group,time%20equivalent%20(FTE)%20basis. (Accessed 29 March 2024)

[iii] https://natcen.ac.uk/publications/public-attitudes-nhs-and-social-care  (Accessed 27 March 2024)

[iv] https://nhssurveys.co.uk/nss/summary_scores/national  (Accessed 27 March 2024)

[v] https://www.england.nhs.uk/publication/our-nhs-people-promise/  (Accessed 20 March 2024)

[vi] https://www.kingsfund.org.uk/insight-and-analysis/press-releases/nhs-staff-survey-2024 (Accessed 27 March 2024)

[vii] https://bmjleader.bmj.com/content/leader/early/2020/11/06/leader-2020-000394.full.pdf

[viii] Leading the Listening Organisation; Creating Organisations that Flourish by Mike Pounsford, Kevin Ruck and Howard Krais (2024)

[ix] “Who’s listening: The Critical Role for Senior Managers” Mike Pounsford, Kevin Ruck and Howard Krais (2022)

[x] Macnamara, J. 2022, ‘Organizational Listening in Public Communication: Emerging theory and practice’, University of Technology Sydney, Australia.

[xi] https://www.youtube.com/watch?v=IwB7NAvKPeo (Accessed 20 March 2024)

[xii] https://podcasts.apple.com/gb/podcast/leadership-culture-in-healthcare/id1734399673 (Accessed 20 March 2024)

[xiii] https://www.hsj.co.uk/hsj-health-check-podcast/hsj-podcast-how-to-be-a-top-nhs-employer/7036737.article (Accessed 20 March 2024)

[xiv] https://oxleas.nhs.uk/news/nhs-staff-survey-shows-oxleas-staff-feel-most-involved-in-the-country-1604

[xv] https://vimeo.com/640306186 (OXLEAS NHS Trust)

[xvi] “Who’s listening: The Critical Role for Senior Managers” Mike Pounsford Kevin Ruck and Howard Krais (Spring 2022)

[xvii] https://www.leadershipacademy.nhs.uk/senior-leadership-support-and-development

[xviii] https://www.ioic.org.uk/learn-develop/the-profession-map.html

Carolyn reflects on the CIPR Professional PR Diploma course

What do you see as the key benefits of having the PR Diploma qualification? 

For me there are two key benefits of having the PR Diploma:  When I joined the NHS, after many years’ freelancing, I realised that most people at my level had a post graduate professional qualification of some sort. So in order to progress my career, it felt essential to study again. I also wanted to validate my experience and know that I had the skills to do my job, particularly as I moved into the public sector for the first time.

What has been your favourite part of the CIPR PR Diploma course so far?

I have enjoyed it all – even though it has been a juggle working full time. My employer has been supportive, however, in giving me study leave to complete my assignments. If I had to pick out a favourite unit, it would be Unit 2 (highlighted above). It suited my journalistic background and I enjoy writing and creating content.

Have you been able to apply any of the learning, and if so, how?

I have applied my learning through better planning of specific communications campaigns, in particular improving the stakeholder analysis and ensuring objectives are much more measurable. I have also evaluated a PR campaign using the AMEC tools for the first time ever.

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