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 (Bournemouth University) 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.

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

We have developed the Systematic Review protocol, which has been registered on PROSPERO: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251246884. 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 Vachelle, who is a Freedom to Speak Up Guardian.

Phase 2: Interview with Middle-Managers and stakeholders

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

Credits:

Created with an image by Wolfilser - "Japanese zen garden with stones in sand"