Pulse publishes report calling for culture to be measured & reported by CQC and NHS-I

Today (6th January 2019) Pulse UK publishes its latest report, providing an in-depth look at the workforce culture in NHS hospital trusts. The report looks at identifying stark trends between ‘outstanding’ and ‘inadequate’ trusts.

Read the full Culture in the NHS 2018 report. A summary of the findings and Pulse UK’s recommendations on how the Care Quality Commission (CQC) and NHS Improvement (NHS-I) should tackle the issue of workforce culture within the NHS can also be found below.

About the ‘Culture in the NHS 2018’ report by Pulse UK

The report aims to understand issues surrounding culture, leadership and accountability at the best and worst performing trusts in the country, as rated by the CQC. It has assessed how these trends affect performance, patient safety and workforce satisfaction. There is a clear correlation between the best performing trusts and the quality of their leadership and workforce culture. Conversely, the worst performing trusts tend to struggle with weaker, less stable leadership and a corrosive workforce culture.

Despite acute issues with culture, ‘inadequate’ trusts routinely fail to address whole workforce culture in a holistic way. The report findings are split into three sections:

  1. strategy and vision
  2. leadership at all levels
  3. learned helplessness and the normalisation of poor behaviour

The report’s findings

Having an articulated strategy and vision is vital for any organisation to succeed, even more so for providers of care with a duty to patients. Pulse found that ‘inadequate’ trusts often had such strategies in place and a vision to deliver the highest standards of patient care. However, these were not deeply embedded among the workforces and as such, demonstrable behaviours were not aligned.

This is borne out in NHS survey data which finds that 88% of staff at ‘outstanding’ trusts believe that care of patients and service users was their organisation’s top priority, compared to an average of just 68% across ‘inadequate’ trusts.

The best organisations also have strong executive leadership teams who empower people at all levels to lead and be solutions focused. The same is true of ‘outstanding’ trusts, where staff are encouraged to do what it takes to deliver the best patient care. For ‘inadequate’ trusts, the existence of fractured relationships and ‘inner circles’ within leadership teams dominate. These factors stifle progress and stimulate turnover of staff, particularly in senior positions.

Another key issue is the existence of learned helplessness. This occurs when an individual experiences repeated adverse situations, leading to a belief that they cannot change the outcome and therefore avoid taking action to ensure no reoccurrence. This is a common issue in many organisations, but particularly in ‘inadequate’ NHS trusts. CQC inspectors found that the normalisation of poor behaviours led to a culture which enabled poor practice to go unchallenged, which undermined patient safety.

Pulse UK’s recommendations

Pulse’s Culture in the NHS 2018 report provides a series of solutions to help trusts and regulators confront issues surrounding culture.

Firstly, culture is mainstay in all CQC reporting, yet it is not actively quantified. Culture can and should be measured.

Secondly, the way a trust views and responds to complaints is a significant factor in turning around a trust’s performance. Trusts must stop being defensive and use complaints as an opportunity to learn and improve.

Thirdly, it is possible to shift from learned helplessness to learned optimism – staff must be empowered to find solutions and congratulated when they do.

Finally, it is impossible to achieve sustainable change without stable leadership. The Government and arms-length bodies must accept that change is a long-term process, encourage leaders to make proper assessments of what is wrong and what needs changing, and give them time to implement the change programmes necessary to improve performance.

For more information

Please contact John Bacon, Head of Programme Delivery for Pulse UK on email at john.bacon@pulseuk.org or telephone on 01603 211089.

30th January 2019