A new report, ‘Culture in the NHS’ claims there is a clear correlation between the best performing Trusts (as rated ‘Outstanding’ by the CQC at the time of the research in August 2018) and the quality of their leadership and workforce culture. Conversely, the worst performing Trusts (rated ‘Inadequate’ by the CQC), tend to struggle with weaker, less stable leadership and a corrosive workforce culture.
The report, published by Pulse UK, a disruptive culture transformation business, finds that staff at Trusts rated inadequate are 20% less likely to believe their Trust prioritises patient care than those at Trusts rated outstanding.
It also finds that staff at ‘inadequate’ Trusts are 20% less likely to recommend their organisation as a place to work or receive treatment; are less confident in reporting unsafe clinical practice; and are less likely to find the procedures for reporting unsafe clinical practice fair or ethical.
Dennis Bacon, Executive Chairman of Pulse UK says: “If ever there was a time for NHS providers, arms-length bodies and everyone else across the health sector to ‘get serious’ about workforce culture, it is now. We are calling on the system to stop confronting the symptoms of poor culture and start tackling the system root causes.”
‘Culture in the NHS’ makes four core recommendations:
Culture can and should be measured
Culture is a core component of CQC reporting, yet it is not actively quantified. Culture should sit with financial reporting, minimum waiting time standards and quality of care performance indicators. Trusts should measure and report their culture to NHS Improvement or the CQC.
Accountability not blame
A blame culture still exists and the NHS must move from this to a culture of accountability. Trusts must stop being defensive and use complaints as an opportunity to learn and improve.
Learned helplessness should give way to learned optimism
‘Learned helplessness’ must be challenged and overturned. This refers to the state of mind whereby an individual feels they have no control and they become unable or unwilling or try to stop adverse situations reoccurring. This is dangerous because it normalises poor behaviour and bad practice. Staff must be empowered to find solutions and congratulated when they do so, which will encourage a move from ‘learned helplessness’ to ‘learned optimism’.
Quick fixes are not the answer
It’s impossible to achieve sustainable change without stable leadership. In the ‘outstanding’ Trusts, leadership is demonstrated by staff at all levels. The Department of Health and Social Care should recognise that change is a long-term process and leaders must be given time to implement the changes necessary to improve performance. This is not helped by rapid turnover of leaders.
Commenting in the introduction to the report, the Rt Hon. Patricia Hewitt, Chair, Norfolk & Waveney STP and former Secretary of State for Health, says: “We can all think of too many cases where a Trust in special measures has been ‘turned around’ in the short term only to fall back into problems because the underlying issues – culture, behaviour and leadership – have not been effectively addressed.
“Unless these are tackled through a focus on workplace culture, we will continue to see adverse effects on quality, safety, sickness, retention and productivity. I hope the recommendations in this report will be welcomed by Trust leaders and adopted by NHS Improvement.”
Click here to read the full report.
