Moving from a Blame Culture to a Just Culture – Seven Key Elements

August 6, 2020 RLDatix Marketing
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Care for the Caregivers<\/em><\/span><\/p>\n\n

As highlighted by NHS England with the NHS People Plan[i]<\/a>, healthcare organisations that prioritise workforce wellbeing will be better placed to put lessons learnt from the coronavirus pandemic into practice. Phil Taylor of RLDatix outlines the benefits of introducing a just culture not a blame culture and shares a methodology for positive change.<\/p>\n\n

Towards the end of 2019, nearly 600,000 NHS employees from 300 NHS organisations, including 229 NHS trusts, took part in what is considered to be one of the largest workforce surveys in the world and the results were enlightening.  When it comes to staff wellbeing, 40.3% of respondents reported feeling unwell as a result of work-related stress, a steady increase over the previous 3 years. 56.6% admitted to going into work despite not feeling well enough to perform their duties.[ii]<\/a>  These statistics are alarming, particularly when you consider they were revealed before the arrival of COVID-19, a hitherto unknown enemy that has shaken and tested the healthcare sector to its very core.<\/p>\n\n

COVID-19 – a powerful catalyst for change<\/span>
\nStaff burnout, stress and sickness are nothing new, however, the pressures on the national healthcare system caused by the pandemic have brought them into sharp focus. While members of the public have shown their appreciation for the remarkable dedication and efforts of health and care staff throughout the crisis through the weekly ‘clap for carers’, leading institutions in the medical world are clamouring for action and in our opinion COVID-19 can prove to be a powerful and beneficial catalyst for change.<\/p>\n\n

A statement published by the Academy of Medical Royal Colleges on behalf of the British Medical Association, NHS Confederation, NHS Providers, Royal College of Nursing and UNISON, calls for better working conditions.  These centre on the five key issues of ‘ensuing the wellbeing of the workforce’, ‘flexible working arrangements and at work facilities’, ‘increasing the supply of workforce’, ‘new ways of delivering care’ and ‘leadership’.[iii]<\/a>  It is interesting to note that ‘ensuring the wellbeing of the workforce’ features top of the list and healthcare organisations should make this their top priority to manage the next stage of the pandemic effectively.<\/p>\n\n

Investigating the root cause of staff stress<\/span>
\nLike all problems, the key to tackling them successfully is to first establish what caused them in the first place.  Similar to many fast-changing industries where staff have a critical role to play, lack of involvement in decision-making and having responsibility, without authority or autonomy, are common stress factors.  Apply this general truth to managing COVID-19 and it’s easy to see how stress levels can quickly escalate out of control.  Leaders were in the invidious position of having to take fast decisions around PPE, ventilators and new contagion measures while doctors, nurses and care home staff were struggling to save lives whilst implementing these new procedures with very little warning, autonomy, or ability to feedback.<\/p>\n\n

In a sector where a blame culture has been evidenced, the greatest stressor for staff, especially during a healthcare crisis like coronavirus, is: What will happen to me if something goes wrong? Poor culture and inflexible guidelines around what staff can and cannot do leaves people feeling unable to intervene to improve system safety and likely to avoid involvement for fear of repercussions.<\/p>\n\n

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Take inspiration from the grieved and bereaved<\/span>
\nThe irony is that most people who have suffered grief and bereavement following the death of a loved one in hospital or a in a care home are actually more concerned with ‘what happened and why?’ rather than ‘who is responsible?’. This is based on patient and public feedback to NHS England and NHS Improvement.  However, the unfortunate reality for many doctors, nurses and other clinical staff is that they are victims of an active blame culture where individual practitioners are held accountable for system failings over which they have no control.  This is bad for staff, bad for patients and it reduces the likelihood that the bereaved will be given the answers and closure they deserve.<\/p>\n\n

What makes a just culture?<\/span>
\nTo redress the balance, NHS England and NHS Improvement have published a guide that advocates a ‘just culture’.  A just culture is fair treatment of staff that supports a culture of fairness, openness and learning in the NHS by making staff feel confident to speak up when things go wrong, rather than fearing blame.
[iv]<\/a>  Supporting staff to be open about mistakes allows valuable lessons to be learnt so the same errors can be prevented.<\/p>\n\n

Another way of considering a just culture is to be guided by the five principles of FREDA (Fairness, Respect, Equality, Dignity and Autonomy)[v]<\/a>.  These form the basis of all international human rights treaties and are today used by the Care Quality Commission (CQC) to regulate health and social care services. Along with the mission of the healthcare sector, which is to preserve the human right to life, we should be making the rights of staff equally sacred. <\/p>\n\n

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Seven key elements for the transformation to a just culture<\/span><\/p>\n\n

Leadership teams who are focused on addressing staff welfare need to include the following elements in their thinking and in doing so will make significant progress in building an open and just safety culture:<\/p>\n\n

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