Challenging the workplace culture of the NHS is key to improving patient safety says NHS Resolution in its latest guidance.
'Being fair: supporting a just and learning culture for staff and patients following incidents in the NHS', highlights the need for the NHS to involve users of care services and staff in safety investigations.
According to co-author, Roger Kline OBE, Research fellow at Middlesex University Business school, the guidance: “Helps to shift the service away from the blame culture that is so prevalent to a culture that balances fairness, kindness and compassion with accountability. It applies to everyone, for patients, their families, staff and organisations and not just when things do not go as planned.”
The paper draws on NHS Resolution’s unique dataset to explore best practice in response to incidents resulting from claims from across the system. NHS Resolution received 317 claims valued at close to £27.5m in the past four years relating to staff stress and bullying in NHS Trusts.
This guidance aims to help the NHS to create an environment to better support staff when things go wrong and to encourage learning from incidents. Key challenges include:
• Fear: The substantial fear of being inappropriately blamed following an incident, the effect on future employment and what peers will think risks preventing NHS staff from sharing and learning.
• Equity and fairness: Research reveals that there is inequity and discrimination at an individual level and disproportionate disciplinary action is experienced by black, Asian and minority ethnic (BAME) staff, with women making twice as many claims as men.
• Bullying and harassment: These sadly compound the understandable stress when things go wrong, leading to burnout and a loss of productivity.
NHS Resolution collaborated with organisations including NHS Improvement and Action against Medical Accidents (AvMA), the UK charity for patient safety and justice who supported the creation of a Just and Learning Culture Charter that Trusts can adopt.
Co-author, Dr Denise Chaffer says: “NHS Resolution’s guidance provides a blueprint for transforming the culture within the NHS to build a more supportive, just and learning environment. It will help create a more consistent approach to investigations when things go wrong, supporting fairer treatment for staff and organisations, enabling them to capitalise on learning and delivering significant benefits to patients.
“To fulfil the ambition in the Long Term Plan to make the NHS the safest healthcare system in the world, we need to foster a more open attitude to patient safety and the ‘Being Fair’ guidance will be an important stepping stone to achieve that.”
Co-author, Dr Suzette Woodward, Senior Advisor Department of Health and Social Care and NHS Resolution adds that improving the culture of the NHS is vital to radically improve patient safety, but cautions that this guidance is just a step in the right direction and more needs to be done.
Minister for Care, Caroline Dinenage, has also welcomed the guidance, saying: “There is a growing recognition that the current approach to disciplinary action makes no clear contribution to better and safety patient care but is likely to discourage learning and, instead, to emphasise blame. This report explains why and how some NHS trusts have started to rethink how they respond when practice does not go as intended within healthcare.”
‘Being fair’ sets out the argument for organisations adopting a more reflective approach to learning from incidents and supporting staff.
