Management responses to staff speaking up in the NHS: a scoping review

Ghorbankhani, Melika ORCID: https://orcid.org/0000-0002-6207-7754, Jones, Aled, James, Alison, Hannigan, Ben and Roche, Dominic (2025) Management responses to staff speaking up in the NHS: a scoping review. British Journal of Healthcare Management, 31 (8). pp. 1-10. ISSN 1358-0574

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Abstract

Staff speaking up about patient safety concerns is crucial to improving care and learning from mistakes. Poor management responses to speaking up can result in missed opportunities to prevent harm and hinder staff learning. This scoping review explored the literature on managers' responses to staff-raised patient safety concerns in the NHS, identifying key factors that influence these responses and suggesting strategies for improvement. Arksey and O'Malley's five-stage framework was used to systematically analyse studies from databases such as MEDLINE, PubMed, EMBASE, APA PsycINFO and CINAHL. The review included 25 studies published between 2005 and 2023. Eleven identified studies were based in the UK, but international literature was also included to expand the insights collected. Three main factors affecting managers' responses to staff speaking up about patient safety concerns were identified: cultural factors; individual factors; and structural factors. A culture of openness, inclusive leadership and clear legal frameworks and guidance were all found to support positive responses to staff speaking up, while the absence of these factors was found to hinder this. This review emphasises the need for a comprehensive approach to management that addresses patient safety concerns raised by staff, focusing on cultural, individual and structural factors.