Introduction

'Forty years ago, when I was a junior doctor, I decided to speak up about a consultant’s malpractice. I went into a senior clinician’s office, explained what I had seen and was then told in no uncertain terms ‘young man, if you value your future career, you will desist immediately with these claims’. So, I did. And it still haunts me today.’

This story is among thousands we have heard in the National Health Service (NHS). Unfortunately, this kind of situation is not relegated to the past—among stories of real promise and heroic action, the NHS is still grappling with issues of bullying, harassment, exclusion and malpractice. Crucially and similar to the numerous organisations we have examined globally and across every industry sector, leaders are still falling into a critical trap that thwarts their ability to improve the situation.

That is, they are focusing their attention and efforts predominantly on those who feel silenced, urging them to ‘be brave’, ‘speak up’ and have the ‘courageous conversations’ that are required. While this is undoubtedly an important initiative, we need to tackle the cultural context1 that means that such bravery and courage is required in the first place.

We need to stop trying to ‘fix the silenced’ and rather ‘fix the system’. This requires us to focus more time and resources on enabling those who are in perceived positions of power to skilfully invite those silenced to speak and then in turn to listen up themselves. It requires us to question and disrupt the very way we socially construct power at work.

In this article, we seek to explore the imperative to speak up and the reasons for silence, the perceptions of speaking and listening up in the NHS, the inevitable blind spots leaders have and what can be done. We …