Table 1

Themes, abstracted themes and participant example quotes

Themes overarching the study findingsThemes overarching the study findings:
Origins of speaking up, Organisational culture and leadership,
Barriers to speaking up, Patient safety
Study areas related to research questions and propositionsFreedom To Speak Up Guardian and Confidential Contact role in an NHS trust
Reflective learning organisation
Patient safety and quality
Abstracted themes within the research areasPowerful personal stories
Sharing personal journey
Raising own concerns
Treatment of themselves and others
Moving forward: reflective learning organisation
Positive steps for change and improvement
Learn from past mistakes
Subsequent detrimental behaviours
Local and national levels
Speaking up
Culture of blame
Bullying, harassment, victimisation
Origins of speaking up: example quotes from focus group responses‘Historically where speaking up came from, there are several high-profile cases – Liverpool, Alder Hey, Cardiac Services. Positive or negative impact from culture & leadership.’ (Participant 2)Mid-Staffs Robert Francis, speaking up instead of whistleblowing, captured current structures of Freedom.’ (Participant 3)
Barriers to speaking up: example quotes from focus group responses‘Appalling behaviors from senior people, juniors felt threatened.’ (Participant 2)‘Fear of speaking up myself and for other staff, fear of repercussions.’ (Participant 7)‘Cultural backgrounds and discrimination.’ (Participant 8)
Patient safety,
staff engagement, staff
health and well-being: example quotes from focus group responses
‘Making yourself vulnerable, human existence you will fail, and how do we handle failure, need to be a reflective learning organisation.’ (Participant 3)Time, roles, prioritise.’ (Participant 4)‘Incident, reason more selfish, colleagues, out of my control, upsetting.’ (Participant 6)
  • NHS, National Health Service.