Speaking up in healthcare
The research is unambiguous, the regulatory expectation is clear, and yet across the NHS every day, clinicians, nurses, and leaders stay silent when they could speak.
Speaking up is hard, and most organisations have never given their people the tools to do it.
The Bravest Path exists to change that.
The barrier
When people face a high-stakes situation, a challenging power dynamic, fear of consequences, or a culture where speaking up has not gone well before, the nervous system responds before the rational brain can intervene.
At The Bravest Path we call these responses Fight, Freeze, Please and Connect. Freeze is going silent: the words are there but they will not come. Please is over-accommodating: softening the message until it disappears. These are the two dominant patterns in healthcare, and the ones most likely to suppress the concerns that need to be heard.
What our work achieves
Across more than 2,000 NHS graduates of Braver than Before®, measured against the behaviours the programme teaches.
of clinical graduates feel more confident raising a patient safety concern with senior colleagues present.
are more likely to speak up after the programme.
are still using the tools every week, more than two years on.
The national picture
Nationally, speaking up is at a five-year low. Only 47.6% of NHS staff are confident their organisation would address a concern they raised, and the People Promise element covering speaking up sits at 6.63 out of 10. Set the 2025 national results against Braver than Before® alumni and the gap shows the scale of the improvement a trust could unlock.
Patient safety
+25pt
Feel secure raising concerns about unsafe clinical practice
NHS Staff Survey Q20a · % agree or strongly agree
Staff voice
+31pt
Feel safe to speak up about anything that concerns them
NHS Staff Survey Q25e · % agree or strongly agree
Staff engagement
+12pt
Enthusiastic about their job
NHS Staff Survey Q2b · % selecting often or always
Both columns measure the same thing, the percentage of staff agreeing, but on different populations. National figures are weighted averages across all 206 participating NHS Trusts (751,088 responses). Braver than Before® figures are self-reported by alumni between six months and two years after completing the programme.
Sources: NHS Staff Survey 2025 National Results Briefing (Survey Coordination Centre) and the Braver than Before® alumni survey.
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How we build speaking up capability
Across an organisation we build self-awareness, self-compassion, and the practical language to speak up effectively.
Our BRAVE conversation framework, developed as part of Braver than Before®, our large-scale transformation programme, gives people a clear and memorable structure for the conversations they would otherwise avoid.
We move teams past building psychological safety and into action, so colleagues actually have the brave conversations with each other, through our Braver Teams programme.
We work on the behaviours that signal to others whether it is safe to speak, through The Braver Board® and Executive Coaching.
Freedom to Speak Up
Our programmes directly support Trust-level Freedom to Speak Up strategies, addressing the internal barriers that FTSU structures alone cannot reach. We also support the CQC Well-Led domain, particularly the leadership culture indicators that inspectors assess.
Why this work is personal
Speaking up is not a soft skill. In healthcare, it is a matter of life and death.
Ten days after our daughter was born, she became seriously ill. We watched her deteriorate, her oxygen levels dropping. And then a nurse spoke up to the consultant. Clearly, directly, and at exactly the right moment.
That conversation changed everything. It accelerated the response, led to her being intubated, and saved her life.
Get started
Email info@thebravestpath.com or call +44 (0)1483 363 088.
Get in touch
Enrol your organisation
Tell us a little about your Trust and we’ll be in touch to discuss cohorts, funding and impact measurements.