In my preparation to organise events designed to spread some evidence-based ideas that affect safety culture in a positive way, themes such as:

- Safety huddles – short multidisciplinary briefings designed to give staff opportunity to understand the current situation with each patient to improve patient care
- 2nd victim support - the effects of an unanticipated patient event, a medical error or patient related injury on staff who have been involved.
- Learning from excellence – studying excellence in healthcare can create new opportunities for learning and improving team resilience.
- Human factor analysis and classification - identifies the human causes of an accident and provides a tool to assist in the investigation process to target training and prevention.

I noticed something common that link all of these, it’s; compassionate leadership and justice.

Michael West et al, in the King’s Fund briefing paper ‘Caring to Change’ (May 2017) lays out the evidence-base for us to direct our attention to the concept of how compassion works amongst us in healthcare in particular. The document touches on a range of characteristics that embody ‘compassionate leadership’. It focuses on the following key characteristics:

- Attentiveness: The importance of giving attention to staff as you are more likely to find new and improved ways of doing things if they feel they are listened to.

- Understanding and trust: Empowering staff to have freedom in their work. Compassionate leaders work in conjunction with staff to make sense of and understand the challenges they face. They operate collectively with shared collective leadership and are not hierarchical and directive, but engaging and supportive which is more effective.

- Empathising: Empathic leadership increases team member motivation, commitment, and engagement. Empathy also creates a more positive emotional environment that is associated with higher levels of creativity and innovation.

In summary, compassionate leadership creates a culture for innovative and high quality care as staff feel valued, to work as a team and develop a mutual understanding to empathise and support each other.

I urge you to read the whole paper, but for now I want to draw the link to justice. Michael J. Sandel in his book ‘Justice’ What’s the right thing to do?, as featured in the BBC Radio 4 Reith Lectures (2009).He helps us to consider and think about justice and the role of justice in our society and our lives.

He pulls linked concepts together that resonate in healthcare such as, doing the right thing, and being bound together, these are held together by the concepts of: Welfare, Freedom and Virtue. Sandel also helps us to explore the concept of Motive, which is presented to us as been driven by the principles of; Morality, Freedom and Reason. In conclusion, in our efforts to create a paradigm shift in our approach and systems of how to learn about patient safety we should tend to these concepts and principles that make up and define culture in our teams, and organisations.

In our support of the HFACS project our aim was to promote a just culture in response to healthcare associated harm, with a shift to take account of the interactions in the wider system of healthcare, and not just on the individual. We have seen that work being followed up now by the publication of ‘The future of NHS patient safety investigation’ March 2018 NHS Improvement, which is both a consultation and a re-affirmation that the purpose of safety investigation itself is conducted for the purposes of learning only. It makes the point that in review, how the process is experienced by staff owing to the manner in which investigations are carried out is the culture change that is now being sort. There are clear references to a sense of injustice of the current process and the need for a positive change in this process through better investigation. Until that processes is completed, we currently have the NHS Improvement ‘A just culture guide’ to support the transparent and consistent application of the RCA process. However, we do not need to wait for the outcome of that process to attend to the welfare of staff.

Staff Trust and Engagement

Many trusts are under unprecedented pressure to improve performance in their services and at the same time through focused leadership many are developing their culture around safety. This is not a question of which one is a priority, or ‘an and or’ question, they are absolutely connected.

There has been a need and drive to re-visit leadership thinking and to re-affirm the behaviours and characteristic which are essentially the licence under which we will chose to operate under (when we have these freedoms and choices) this is what Michael Sandel describes as ‘Doing the right thing.’

On 29th March 2018, the PSC launched a Community of Practice (CoP) to bring together trusts and organisations across the region who want to learn more about how to support staff and develop a support service. We heard from researchers about some of the core themes from interviews conducted with staff at two local trusts. The common themes that came from these interviews included:

- Victimisation/self-blame – participants felt lack of control, vulnerable, not being heard, fear, guilt and feeling responsible for the patient and their families.

- Cognitions – Following the event, participants reported a lack of confidence and doubt in their own abilities and their ability to carry out their job leading to reduced professional self-efficacy, double checking, intrusive thoughts, flash backs and rumination.

- Heightened emotionality – Participants reported feeling very high emotions after the event, many felt very angry at the situation, the decisions made, and the response from others including the organisation. They were highly anxious, sad, upset, irritable, depressed and traumatised.

- Coping behaviour – Many demonstrated a physical response such as difficulty sleeping. Some demonstrated negative coping behaviours such as increased alcohol use, others used more positive coping behaviours such as exercise, seeking support from others (colleagues and family) or avoidant behaviours such as avoiding work, the ward where the incident occurred or patient and their families.

- Organisational support – participants described the support participants received during the incident and the support they wished they had. Many participants felt supported by their team and colleagues but wished they received more support from the management and organisation leading to a lack of faith in the organisation and a lack of commitment to the organisation.

- Patient safety and culture – Many reported being frustrated by the response of the organisation during the investigation, they felt they were being blamed and not treated fairly with many fearing repercussions this would bring.

For your diary – in support of our work to spread Learning from Excellence we are providing Appreciative Inquiry training for some staff on the 16th and 17th July with further opportunities on 9th, 10th and 11th Oct 2018. This dialogue technique that is supported by evidence and social practice, will be followed with additional support and further developments of joint working between the East and West Midlands Patient Safety Collaboratives.

For any further information or for any queries on the topics covered please contact:

Colin Moorhouse

Patient Safety Fellow, Patient Safety Collaborative, East Midlands Academic Health Science Network.

Email: This email address is being protected from spambots. You need JavaScript enabled to view it. 

Mobile: 07976625678