Talk Health and Care

A just culture

This is a brave question to ask at the moment and with out undoubted future challenges. Thank you for asking it. The answer is complex.

1. There is double blind software that captures blame, bullying, unfairness that could be held centrally and triangulated with FTSU, CQC and other regulators’ insight. Sir Robert’s leadership of Healthwatch is a great opportunity. 

2. The NHS staff survey captures data, can we share (better) what good looks like. How could that be replicated in Social Care? It is important to showcase best practice to the General Public too who also contribute to culture. 

3. A fair day’s work for a fair day’s pay, ensuring the workforce feels valued is a leadership challenge ( from most senior to frontline) we are failing, opportunities for personal progression are currently inequitable.

4. There are wonderful people working in Health and Social Care. Can we shine more light on them and a harsher light on bad practice.

5. Make corporate forums e.g. Boards, Cabinets genuinely co-productive with equal and shared representation of the workforce and service users. This will require a conscious decision to fund time and space to do so.

We have many elected officials, advocacy, trade union and professional organisation partners. There should be reviews of current, absent or dysfunctional forums to focus on this agenda. 

Think of a safety incident with a patient or service user where you or a colleague have felt supported and treated in a fair way in your workplace. Explain why you felt this.

Sadly as a mentor of many staff, my experience is of the reverse.

If there is a safety incident it is a sign that something is wrong - primarily at organisational and/or system level

The best example I’ve seen was a US hospital documentary ‘ I’m so thankful you told me’ - start there 

Now think of a time where you have not felt supported or treated fairly in the workplace. Explain why you felt this.

Responses reflect fear of litigation and reputational damage, poor management practice, lack of education and training, unrealistic caseloads. 

People try to do their best as they see it.

What could have been done differently to make you feel better supported and treated fairly?

The initial response had to be no blame in word, deed, action

Individualised response to the matter 

Review recruitment practice and support for all line managers, to the most senior

What would be useful in helping develop a just culture?

Please see above 

Commenting is closed

Adam DHSC Jan 21, 2019

Hi Lynne and thank you for your well thought through ideas.

There are a number of points you have raised here ... I will look into them and get back to you.


Wayne Robson Jan 22, 2019

Hi Lynn, I am Wayne Robson from the NHSI patient safety team. Thank you for your insightful comments. I agree we must triangulate all the data available that relates to just culture, and support organisations who score highest on the staff survey questions relating to just culture, to share what they are doing so others can learn from this. In terms of your own experiences have you come across our Just Culture Guide ? - and do you think this could make a difference?
On the Just Culture Guide web page we also have a write up of the focus group we held with organisations that scored highly in the staff survey question “My organisation treats staff who are involved in an error, near miss or incident fairly”