A unique NHS-academic partnership in the North East of England has led an initiative to focus on staff safety and morale, which is delivering significant cost savings. Northumbria University and Mersey Care NHS Foundation Trust are pioneering professional development courses on Restorative Just Culture. This approach at the Liverpool-based Trust has seen reduced dismissals and suspensions, leading to substantial business savings, and has generated great interest across the health sector.
Starting in 2016 Mersey Care has worked to deliver a Restorative Just Culture. And despite increasing its workforce by 135%, the Trust has since seen an 85% reduction in disciplinary investigations and a 95% reduction in suspensions - helping it to drive down costs significantly. During the same period, it has also seen improved staff engagement and safety culture scores as measured by the NHS national staff survey.
Mersey Care’s Executive Director of Workforce Amanda Oates says: “Mersey Care started on our journey towards a Restorative Just and Learning Culture after conversations with our staff about the barriers staff faced delivering the best care that they could possibly give.
“The feedback was overwhelmingly about the fear of blame if something didn't go as expected. This was preventing staff from telling us what wasn’t working. More importantly, it was preventing the opportunity for learning from those things to prevent them from happening again. As a Board, we had the conversation - are we looking at problems the wrong way?”
Seeing benefits to staff and its delivery of care, Mersey Care sought out academic expertise from Northumbria University to create an accredited course that enables other NHS Trusts and indeed other types of organisations to establish a Restorative Just Culture too.
What is Restorative Just Culture?
Restorative Justice is an approach favoured by distinguished academic Professor Sidney Dekker of Griffith University in Brisbane, Australia. It works to replace a culture of blame and fear with a culture of trust, learning and accountability.
It recognises the welfare of a range of stakeholders such as employees, patients and clients, where an employee relations matter has arisen. These matters could include bullying, harassment, grievances, disciplinaries or an adverse event.
The Restorative Just Culture approach deals with adverse events and incidents by asking, who is hurt; what do they need; and whose obligation is it to meet those needs? In turn, this builds teams that feel psychologically safe to speak out, take interpersonal risks and, in a healthcare setting, make decisions to provide safe and continuous care without fear of retribution or marginalisation.
A transformative learning programme
The new four-day programme teaches the theory behind Restorative Just Culture and its application in complex organisations. Any professionals and practitioners who are involved in the management and welfare of a range of stakeholders in any industry will benefit from it.
It aims to teach learners how to manage these issues in a restorative way that minimises the negative impacts, maximises the learning and develops an organisational culture where people feel safe.
In his powerful film about Mersey Care’s journey, Professor Sidney Dekker says: “An incident is something that you have already invested in – what you need to do is to get a return on that investment. A restorative just culture allows you to get that return, to learn from it, to not send people away who are involved in it because they are the embodiment of the really expensive lesson that you’re not learning. A single organisation that gets this is really hard to find. Look at Mersey Care. Look at what these people are doing!”
Northumbria Senior Lecturer in Leadership and Management and Restorative Just Culture Programme Leader, Kristina Brown, believes that the benefits that Mersey Care has seen are possible for any organisation that is prepared to implement a Restorative Just Culture.
“There is a growing body of evidence linking staff wellbeing and negative workforce factors to levels of team effectiveness and the quality of care that a patient will receive,” she explains. A recent NHS Patient Safety Strategy highlighted the cost to patient safety resulting from healthcare teams that do not feel supported to carry out patient care, estimating that 11,000 lives go unsaved and a further £1 billion is spent on treatment following unnecessary incidents.
“Healthcare professionals are central to these efforts and managing relations that have arisen from any event in the restorative approaches of compassion, civility and respect is crucial not only for patient safety but a health worker’s physical and psychological wellbeing.”
High praise and collaborations
After a successful pilot course in June, the programme has been highly praised by Trusts throughout the UK, who have also seen reductions in suspensions, investigations and disciplinaries and have witnessed the impact that managing relations with compassion, civility and respect has had to people’s lives.
Now the programme has been highlighted in the ‘We are the NHS: People Plan 2020/21-action for us all’ and is being showcased by the NHS Employers, the Public Service People Managers Association and the CIPD.
Such has been the success of the programme that the UK’s Zero Suicide Alliance is also utilising it to help support and facilitate the work they are doing to prevent suicide in the UK and beyond.
Available for organisational or combined organisational bookings for up to 40 delegates, the programme is delivered by experts from Mersey Care NHS Foundation Trust and Northumbria University.
The course is delivered remotely as a fully interactive digital programme, with some dates already being fully booked for 2020/21 and further courses to be launched from summer 2021 onwards. The programme is taught in four days over a three-week period and is also supported with a live Q&A session and post programme action learning set.
