How Mersey Care focused their workplace culture on justice and learning
What is a just culture?
Simply speaking a Just Culture means an environment where we put equal emphasis on fairness, accountability and learning when something has not gone as planned or expected. We ask, what happened? Not “who is to blame?”.
That said, a Just and Learning Culture is not the same as an uncritically tolerant culture where anything goes – that would be as inexcusable as a blame culture.
In 2018 to support our Just Culture work, Mersey Care created a workstream dedicated to Civility and Respect, with senior representation, staff side, colleagues from our staff networks, communications and crucially from across clinical services. They developed a framework and practical tools aligned to our Trust values that fosters and supports civility in practice.
More information is available here: The Mersey Care Just and Learning Culture
What makes it different from your culture before?
As part of our review into people processes, we had in depth discussions with staff and staff side to understand their issues and concerns that affected them in their roles. The staff indicated a fear of blame and retribution when things didn’t go as planned. There was a perception that the trust jumped into formal proceedings. We needed to change. We needed to increase staff candour when things did not go as planned. Moving from blame to learning would improve the conditions for staff, ultimately improving the quality of the service for patients.
Why did you do it?
We are always looking to improve experience for patients. We had our own evidence and we looked at how we could change culture and practices using the best academic thinking around workplace cultures. We wanted to know what was preventing staff from raising concerns or highlighting problems. As a trust, from the very top, we wanted to improve staff’s ability to be candid and raise concerns when they arise to ensure a higher level of patient safety. We wanted to review and improve policies and procedures with a real understanding how they were being applied in practice. Many members of staff voiced concerns that they felt like victims of the current processes rather than perpetrators.
How did you go about changing it?
We really focused on a collaborative approach with all members of staff at every level. Easy to say but we meant it and it had to be led by the Board, totally owned by them and with really close engagement with staff side. I can’t stress enough without true collaboration with staff side, this would have never have been as effective nor had the desired impact.
We started by drawing up objectives and strategy for implementing new policies and procedures together. We then were able to pilot them in specific parts of the service to allow for phased full implementation.
We worked closely with academic colleagues in creating tools and delivering workshops for staff, as well as working on our four-step approach.
Examples of the training modules that staff undertook can be found here.
How long did it take to change from the previous culture?
We started the investigative work in 2014 and began implementing to our staff in 2016. Following successful pilot outcomes, we were able to see a real impact in the first 12 months with formal employee relations cases seeing a significant reduction.
Even with acquisitions of other organisations and growth of Mersey Care we have been able to reduce the risk to patients since we introduced the new policies.
How do you plan to sustain the change to your culture?
To maintain the change in culture and behaviours requires effort from all levels of staff. In particular we have ensured our board and management are visibly involved in supporting and demonstrating behaviours. This authenticity in leadership has been essential in growing and allow the change in culture to be organic.
Consistent training each year is also provided for staff and particularly HR staff. This helps maintain a focus on the important elements of the culture. We have also ensured that as the organisation has grown, we familiarise new starters with our culture of understanding and learning in the onboarding process.
Overall, sustaining this culture is about being better each day and constantly learning rather than expecting a ‘boom’ moment when everything is finished and fixed. This realistic approach leads us to be always working to move in the right direction.
What benefits have you seen from the change in culture?
Some noticeable benefits we have found:
- improvement in people process for staff
- improvement in staff speaking up, thus reducing the bystander effect
- reduction in bullying and harassment
- no more ‘im just a porter’ or ‘im just band x’, we have created a unified approach that values all input
Overall, this progress with our staff has meant a great deal to the service we provide to patients and ensuring their safety.
If you were giving a piece of advice to another employer changing their culture, what would it be?
Making people the centre of your approach is essential for changing your culture. For instance, we found that some viewpoints expressed by staff were not accurately reflected in the data we had gathered. We did not simply dismiss them as a misconception but really tried to understand the human aspect of our policies and procedures and staff feelings towards them.
Furthermore, we realised the way we communicate as an organisation is very important to make individuals feel supported and safe. As such we ensured the choice of words in our policies and procedures is careful not to induce fear or panic in staff.
Restorative Just Culture isn’t an off the shelf quick fix. It takes time! It must, really must, be led by a committed range of senior leaders, professionals willing to change, staff side and clinical colleagues. It’s worth it, it makes a difference to morale, patients and culture but it requires real focus over the longer term. However, I must stress there remains more to do!