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Exploring how healthcare middle-managers experience and manage the speaking up process, and the impact on their wellbeing: a mixed-methods study

Funded by the MPS Foundation and adopted by NIHR

Project Aim

The research project aims to expand knowledge about how NHS middle-managers, who manage frontline healthcare staff, experience and manage the speaking up process and how that affects their wellbeing. Speaking up is defined as communicating anything that hinders patient care and patient safety (e.g., unsafe practice), or that affects staff wellbeing (e.g., bullying, harassment) and is crucial to patient care, patient safety, and staff wellbeing. For more information about this project, please contact Professor Ann Ooms by email (A.Ooms@kingston.ac.uk).

Project Team

This 2-year research project, funded by the MPS Foundation and adopted by NIHR, is led by Professor Ann Ooms (Kingston University London) as Principal Investigator, and Dr Celayne Heaton-Shrestha (Kingston University London) as Second Principal Investigator. Dr Theodora Stroumpouki (University of West London) and Dr Helena De Rezende (University of Limerick) are Co-Investigators. Dr Sarah Spence (Kingston University London) and Dr Chao Wang (Kingston University London) will also contribute to the project. Throughout the project, the research team will work in collaboration with an Advisory Group.

Advisory Group

Throughout the project, we are working in collaboration with an Advisory Group, which includes the following members:

  1. Maxine Gates, Service Manager Cardiology, Respiratory, Diabetes, Endocrine and Renal Services - Kingston & Richmond NHS Foundation Trust
  2. Marion Louki, Director of Midwifery - Kingston & Richmond NHS Foundation Trust
  3. Tom Quinn, Emeritus Professor Kingston University and Honorary Fellow of the College of Paramedics
  4. Stephen Summers, Staff Pastoral Wellbeing Practitioner -  Kingston & Richmond NHS Foundation Trust
  5. Tara Vachell, Freedom To Speak Up Guardian – University Hospital Dorset NHS Foundation Trust

Research Questions

The project aims to address the following five research questions:

  1. How do middle-managers experience the Speaking Up process?
  2. How do middle-managers manage and make decisions about following up on Speaking Up messages?
  3. What is the perceived impact, if any, of managing the Speaking Up process on the wellbeing of middle-managers?
  4. What are the enablers and barriers experienced by middle-managers when managing the Speaking Up process?
  5. What changes are needed or desirable at different levels (individual, team, hospital, and policy levels) to enhance the Speaking Up process?

Methodology

To gain a comprehensive understanding, the project follows a four-phase, exploratory sequential mixed-methods design, providing depth and breadth, each phase informing the next. Phase 1: A mixed-methods systematic review Phase 2: Interviews with middle-managers and stakeholders Phase 3: Questionnaire for middle-managers Phase 4: Validation and development of recommendations

Progress to date

Phase 1: Mixed-Methods Systematic Review

The Systematic Review is led by Dr Helena De Rezende, in collaboration with Professor Ann Ooms, Dr Celayne Heaton-Shrestha, Dr Theodora Stroumpouki, Dr Sarah Spence, and Tara Vachell. The Systematic Review protocol has been registered on PROSPERO: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251246884.

Phase 2: Interview with Middle-Managers and stakeholders

We have developed the documents for ethics application, which we aim to submit in March 2026.

Credits:

Website developed by Professor Ann Ooms