Hunt seeks to address a culture of cover-ups amidst fears of prosecution of doctors. But beware…

Article written by Dennis Bacon, Executive Chairman

We all make mistakes but some can have quite profound and occasionally devastating consequences on others. NHS staff are no different, but as an institution, work needs to be done on how it responds to such events. A ‘blame culture’ rather than a ‘learning culture’ too often prevails. Given this environment, do we need to do more to create a culture of learning? – i.e. when we say we are sorry and that lessons will be learned, we really mean it. Encouraging doctors and other healthcare professionals to take responsibility and to be transparent when things go wrong is no easy task, especially when some are fearing for their livelihoods and in some cases a threat of custodial sentences.

Recently, Health and Social Care Secretary, Jeremy Hunt, attempted to strike a difficult balance by reassuring families that scrutiny would be robust, while telling doctors that the priority was on learning and avoiding future mistakes, rather than on blame and punishment.

Our research puts an interesting take on this conundrum.  We know that when employees focus on their individual needs (and concerns) at the expense of working collaboratively to achieve shared goals and improve performance, adverse effects will follow. These adverse effects are not only felt by patients and their families and friends, but by other health care workers, whose self-worth and sense of wellbeing also takes a hit. How do we encourage these people to focus on the best interests of the organisation and those they serve, rather than on their own self-interests and self-preservation, when the stakes are so high?

Blame shifting has had a profoundly detrimental effect on the NHS’s ability to improve and promote accountability, and the ability of health care professionals to make decisions that are in the best interest of their patients. One significant piece of research we conducted within a large public sector organisation told us that 85% of staff had witnessed blame being shifted by their colleagues to justify why their responsibilities or duties had not been achieved. We also found that more than 50% of comments by employees were driven by a sense of individual entitlement. This means that staff were more concerned about the potential effects on themselves rather than the organisation and the very people the organisation served.

Another factor fueling this problem is the rather unhelpful but universally adopted staff engagement survey, which tends to ask what employees want, rather than ask them about what they think the organisation needs and what ideas they have to improve outcomes.  Culture expert Chris Cancialosi questions the sense in employee surveys – ‘once a year I’ll ask my employees what they don’t like, and I’ll spend the next year of my life as a leader trying to fix it all’.

Top items on the ‘wants’ list are unsurprising; better remuneration, additional resources, better management, greater leadership and more training.  But we also know from studying a large amount of psychological research that people are more likely to want to work for organisations that have a good culture, and would accept less remuneration to work in a happy and productive workplace. It is also impossible for organisations to meet the individual needs of all staff, and so continually asking the same questions and then failing to deliver on the responses only adds to the problem.

The positive take-away from our findings, however, is that the pathway to improved organisational culture and performance is relatively clear.  Focus staff away from ‘entitlement behaviours’ and instead get them to focus on working collectively to achieve shared goals.  We know that it is possible to create an ‘intentional culture’, one where staff consistently demonstrate the right behaviours and are held accountable to them. We have devised the only way of scoring and measuring the shift in behaviours against key performance measures. It will not surprise you that as an organisation’s culture improves so does its performance. In the case of health and care, our core market, we have helped improve the culture of NHS and care providers, who have in turn achieved significant improvements in patient safety and satisfaction, fewer clinical errors, better staff attendance and, over time, a reduction in the use of agency staff. A ‘win-win’ for everyone, most importantly the patient.

So, as Jeremy Hunt considers where to draw the line between what is an honest mistake from which lessons should be learned, and what constitutes very poor performance requiring disciplinary action or prosecution, health services can proactively tackle whole workforce culture. Preserving the status quo and simply paying lip service to improving this key area of our NHS will no longer do.

1st July 2018