The Conversations That Happen After the Meeting: Speaking Up in Health and Social Care

I don't often talk about why I left one organisation. It wasn't one conversation or one decision. It happened gradually.

The most honest conversations never happened in the room where the decisions were being made; they happened afterwards. I'd leave the meeting, gather my things and start walking back to the office when someone would quietly say, "Have you got a minute?" Sometimes my phone would ring later that evening. The conversations nearly always started in exactly the same way: "I didn't want to say this in the meeting." "Can I be honest?"

People weren't telling me shocking secrets. They were talking about everyday things that were getting in the way of providing good care: a process that wasn't working, a decision that hadn't landed well, concerns that had already been raised more than once, or ideas that could have made life easier for residents, families or colleagues.

Nothing that should have needed a private conversation. That's the part I found difficult.

Not that people had concerns. I'd expect that. Health and social care is complicated. If everyone agreed all the time, I'd be more worried. It was that people no longer believed the meeting was the right place to have those conversations.

What frustrated me was that none of these conversations came as a surprise. Most of the people in the room already knew there was an issue. They just weren't talking about it together.

Over the years, I've come to realise that culture isn't always obvious. Sometimes you only notice it in the hesitation before someone answers a question, or in the person who waits until everyone else has left the room.

When I carry out quality reviews now, I still pay attention to the audits and the evidence. But I also watch the people. Who speaks first? Who never speaks at all? Who changes what they were about to say when someone more senior walks into the room? Who waits until we're walking back down the corridor before saying, "What I really think is..."?

Those moments tell me far more than most governance reports ever will.

Creating a culture where people feel confident speaking up in health and social care isn't as simple as asking the question. Most people won't tell you they don't feel safe to speak. They'll show you.

If the real conversation only starts once the meeting has ended, I'd want to understand why. I want to understand what has happened that made people decide silence was the safer option.

Once people stop believing their voice matters, organisations lose something they can't replace: trust. Without trust, improvement becomes much harder than it needs to be.