Caring for the people that care

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2019-09-23

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Our fourth annual patient safety forum provided the opportunity to discuss and explore what it means to build a just culture for patients and staff.

Ahead of the recent publication by NHS Resolution of Being fair: supporting a just and learning culture for staff and patients following incidents in the NHS, the three co-authors of this study shared their experience and insight on the approach required to support such an ethos.

Dr Denise Chaffer, Director of Safety and Learning at NHS Resolution, highlighted the unintended impacts of the processes leading to the disciplining of employees following honest mistakes. Discouraging people from coming forward to admit an error, the processes can also result in very capable practitioners feeling unable to remain in the NHS.

Drawing on her own experiences of managing staff within acute and community settings, Denise explained that where a policy does not work practically for people, workarounds are understandably created, and that is when errors can occur. Rather than assuming it is a matter of individual capability, Denise pointed to the importance of questioning whether it is in fact a system issue. Denise further highlighted that:

Supporting a just and learning culture is important for both patients, and staff to support improvements in patient safety by promoting open, and trusting relationships.

Roger Kline OBE, a Research Fellow at Middlesex University Business School, emphasised the need to move away from disciplinary processes that seemingly focus on attributing blame, rather than on what can be learned when things do not go as intended. With a focus on the financial as well as the wider costs of many existing disciplinary processes (for example, high absence levels), encouragingly Roger noted that there is a climate for change. The approach taken by Mersey Care NHS Trust was cited as one example of the hugely positive impact that a change of focus to policies that assist practice (as opposed to punishing staff) can have.

Having also co-authored Fair to Refer’, (a report commissioned by the General Medical Council), Roger drew attention to the need to address the disproportionate number of fitness to practice concern referrals for doctors from black, Asian and minority ethnic groups.

Dr Suzette Woodward, Senior Advisor for the Department of Health and Social Care and NHS Resolution, underlined the need for a positive culture that supports staff morale, health and wellbeing as a key component of patient safety. Echoing the views of her fellow speakers, Suzette pointed to the necessity of tackling the blame culture together, and in doing so called for greater understanding of what information is being captured (and importantly, why) following a safety incident. Suzette emphasised the importance of seeing safety as success, rather than as failure and that having the right culture for that is crucial.

It is clear that whilst organisations within the NHS are at different stages along this journey, positive steps are being taken towards building a just and fair culture.

Related item: The General Medical Council: rebuilding trust