Changing attitudes and patterns of behaviour in the workplace: An interview with Shaun Keep and Paul Adams

Summary

Across healthcare, social care and countless other industries, safeguarding failures, misconduct and preventable workplace incidents are too often preceded by missed opportunities to act. Staff frequently suspect issues but feel unable or unsafe to speak up. Internal processes for speaking up fail to gain trust and inspection bodies rely on outdated ‘tick-box’ policies. The result? Blind leadership, compromised quality output, costly crises, avoidable trauma, damaged reputations and lost talent.

In this interview, Shaun Keep and Paul Adams, founders of Say So, discuss from their experiences some of the reasons why staff don’t feel able to speak up and why and how we can change attitudes and patterns of behaviour in the workplace.

About the Author

Shaun Keep and Paul Adams are the founders of Say So. Say So's mission is to create positive and successful workplaces and provides a reporting and support service for employees and organisations. It is being used by over 65 care homes, 12 UK fire and rescue services and organisations in sectors ranging from charities to hospitality. 

Questions & Answers

Hi Shaun and Paul, can you tell us about your backgrounds and how you got involved in patient safety incidents and supporting staff to speak up

Following careers in police and social services, charities and religious institutions specialising in safeguarding operations and policy, we were asked to review 125 ‘serious care failures’. These were all allegations of abuse or neglect of service users in residential care settings and clearly all the alleged victims were vulnerable persons.

What we found was staggering to us—in 65% of these cases, staff in the care homes were aware of shortfalls, corner cutting, falling standards and, in some cases, misconduct prior to the serious allegation emerging.  But they didn’t report what they knew!

Now, being career-long safeguarding professionals, we felt this was both unacceptable and an opportunity to prevent many of these incidents in the future if we could design a process that was safe and trusted by health and care professionals for reporting these matters. In 2017 we set up 'Say So'; we are now not only working in the health and care sectors, but also emergency services, police and hospitality, and we are growing in government and local authorities too.  

What type of concerns do you see raised?

So far in 2025, we have found that abuse (emotional, physical, sexual, verbal and psychological) makes up 29% of all the concerns that have been raised with us, 12.5% are around code of conduct (other than abuse), 11% health and safety issues, and 33% performance and efficiency concerns.  

Why do you think the staff involved in patient safety incidences don’t speak up?

We found that the main reasons for staff being reluctant to raise concerns were fear of dismissal, fear of mistreatment by their employer, fear of bullying by colleagues, or they didn’t want or couldn’t cope with the stress of reporting and making an allegation.

What patterns are you seeing with how managers and organisations respond to staff when they speak up? Is it improving?

Those organisations that have chosen external, independent speak up services are usually those pushing the envelope of staff engagement and whose leaders understand more of the benefits of listening to staff. We have seen the rise in HR staff being more willing to engage to address workplace issues, and the willingness to commission external investigators too where they feel that expertise is required. 

It’s all about full ‘buy-in’ to the principle of respect for your staff—indeed an organisation's staff are usually the most expensive asset and should be treasured and nurtured to get the optimum return. We have certainly seen the dial shift towards greater understanding of this issue. 

What advice would you give staff who are thinking about speaking up within their organisation/team culture?

Our approach has always been to encourage staff to speak up early, using their training, experience or common sense when they become aware of a risk. If matters can be identified and addressed before serious harm occurs, this will be seen as a success from all viewpoints and often will avoid punitive action from employers who see staff development and preventative measures as the best option.

However, if you have genuine fears of how you will be treated by your employer or colleagues then consider reporting anonymously to see how seriously the organisation takes your information. Remember though, if your employer has an internally managed speak up process, it may be difficult to remain anonymous. If the matter persists unaddressed then seek advice: (1) From your Union if you are a member or (2) from the charity Protect who are available for advice (although they do not take reports).

If the matter is a safeguarding concern, then please do consider the safeguarding route via your local safeguarding processes (you can remain anonymous).

What are the advantages for staff using an independent organisation to raise a concern?

We have found that when staff have a safe and trusted route to raise issues then all manner of issues can become visible to the leadership. Previously unreported issues unknown to senior management are able to be assessed and addressed, including risks and concerns impacting both staff and patients. Don’t forget, as a group, staff know more about what happens in an organisation than the leadership team. They generally have ‘access-all-areas’ visibility and are present 24/7 across the organisation.

Independent organisation like Say So are designed to transform workplace culture and mitigate risk by offering staff a safe, independent channel for raising concerns—before issues escalate. We operate entirely outside the client organisation, earning authentic staff trust. It’s completely confidential and reports are received and triaged by experienced safeguarding and investigation professionals. The staff member raising the concern receives updates and can supply additional information securely. It provides a safe environment for staff to raise concerns without fear of retribution and protects individuals caught within a toxic culture.

What are the benefits for an NHS trust or care home or other healthcare provider to use an independent service for staff to raise concerns?

Apart from what I have already explained, that leaders get greater visibility of their organisation thereby enabling enhanced ability to manage current risks, our advanced data platform identifies trends, emerging risks and sector-wide insights, enabling proactive harm reduction measures. It offers improved risk management, improved standards of service and improved workplace culture, dynamics and relationships.

By identifying trends and themes, it allows greater visibility of emerging issues and potential risks and early intervention opportunities to prevent major incidents. It encourages stronger internal communications and openness and the ability to address conflicts, bullying, discrimination and inefficiencies. Longer term, listening and acting on the information and data will improve staff retention, recruitment and satisfaction. It serves to enhance inspection ratings in leadership, governance and workplace safety, and significantly reduces legal expenses, tribunal costs and fines.

With the collected data we are now able to provide member organisations and affiliates access to ‘big picture’ intelligence that is building daily and can be used to indicate and evidence patterns, changes and persistent behaviours/incidents that can be addressed through longer term strategic thinking and action.

And finally, what are the positive changes you have seen when staff have raised concerns?

One example of changes to practice was when a concern was raised in a care home that medication was regularly being left unsecure and unsupervised, sometimes for longer than 30 minutes, which is obviously a patient safety issue. This was investigated by the care home manager and resulted in staff development; supervision and security improved with follow up checks. 

Another example was an issue around some equipment (personal hoist) being used by untrained staff, which resulted in the staff development and training. 

Misconduct, including sexual harassment and bullying, have been identified and successfully addressed through management investigation and action, many emanating from anonymous concerns. For example, we received information that a care staff member had verbally threatened a patient with dementia and regularly abused residents in this way. The local manager investigated this and it resulted in the staff member being dismissed for this and other breaches of conduct.

Other staff conflict issues have been successfully raised and addressed. Interestingly, in at least one case, mediation was used to resolve ongoing conflict between teams who misunderstood each other’s roles and demands, and were at ‘loggerheads’, which undermined performance.

More broadly, in medium to large organisations, we have found examples of ‘silo-thinking’, where specialisms such as HR, IT, transport, buildings and maintenance, etc., have operated to their priorities (or convenience) rather than the priority of the operational teams (whom the specialisms are meant to support). We have been able to bring these matters to the leadership team directly and changes were implemented immediately.

Related reading on the hub:

• Speaking up for patient safety: A new interview series about raising concerns and whistleblowing
• Key themes emerging from our ‘Speaking up for patient safety’ interview series - Speaking up for patient safety interview series
• The whistleblower playbook
• Speaking up and whistleblowing: Where to get information and support
• Professor Jane Somerville: Supporting doctors who speak up for patient safety

Opinions expressed in blogs and other content are those of the author. Patient Safety Learning welcomes sharing content and opinions that promotes safer patient care and for the reduction of avoidable harm.  The views expressed on the hub however do not necessarily represent Patient Safety Learning's views or values. References to a specific product or service does not imply a recommendation or endorsement.