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How can we create a just culture in the NHS and Social Care?

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***A Just Culture is where staff involved in safety incidents are confident they will be treated in a consistent, constructive and fair way and not unfairly blamed***

Staff who work in health and social care are often concerned that when a safety incident happens there will be too much focus on what they did or didn’t do, and that the context of the incident and wider factors to do with their organisation will not be considered.

Evidence from across other industries and countries tells us that punishing people when they make mistakes will not mean they make fewer mistakes. Blaming people for error does not improve safety. We should instead focus on changing things to make it easier for people to do their jobs safely and without fear of blame.

We need to embed a just culture.

We want to hear from you about what gets in the way of a just culture and what we can do better.

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
Think of a time where you have not felt supported or treated fairly in the workplace
What could have been done differently to make you feel better supported and treated fairly?
What would be useful in helping develop a just culture?

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Failure to do hand hygiene is interesting.  It truly could be a slip or a lapse which would warrant consoling the person per just culture.  It could also be at-risk behavior (the risk is judged to be small by the person).  This would receive coaching in just culture.  Note that if the behavior persists despite coaching, it would warrant a punitive response.  But one could also judge that failure to do hand hygiene is an egregious action and should be met with a punitive response.  Most...

Charles Murphy
by Charles Murphy
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Charles Murphy

One major issue is that the just culture response to a behavior should not be based on the outcome. Example:  if a surgeon or surgical team do not perform a pause and there is a wrong site surgery, this results in a punitive response (this is consistent with just culture).  The problem is that in many cases, if the surgeon or a team does not do a pause or does it in a cursory manner, then there is no punitive response to that action (and based on just culture, there should be).

Charles Murphy
by Charles Murphy
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Charles Murphy

we have made huge progress in listening and understanding the patient voice with many organisations having patient stories at Board - I believe we should do the same for sat stories so where appropriate and with support staff can share their experiences for all to hear and learn from

Karen Martin
by Karen Martin
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Comments 2
Karen Martin
Idea thumbnail

The idea is simple, the implementation less so (though we do have a full explanation of it fi you wish to contact us). 1) Accept that staff come to work to do the best they can. 2) Accept that we work in a complicated and sometimes complex/chaotic environment. 3) Know that in complex environments it is rare that one individual has the answer; that to get to the best answer we need to have as many different perspectives (including patients') as possible and that they need to be...

Chris Turner
by Chris Turner
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Comments 0
Chris Turner

Currently the understanding of what causes errors in healthcare is very immature - as such staff as seen as the weakness in the system and errors are presumed to be human ones and hence focus is still on blaming individuals -thi seems is reinforced by attitudes at multiple levels in NHS provider organizations and regulators and arms length bodies. We fail to globally recognise the cause of errors in healthcare and the new fail to fix it.  The RCA process is reactive the need is to...

Mark Hellaby
by Mark Hellaby
0 Votes
Comments 2
Mark Hellaby

We are committed to engendering a generative and participatory safety culture, in what is said, what is done and, more importantly, what is believed. Such a culture can be considered to have four primary elements - the Just Culture, the Reporting Culture, the Flexible Culture and the Learning Culture, with a fifth element, the Questioning Culture, being the defence against assumptions and the mechanism for delivering rigour in our approach to safety. These five elements combine to form a...

Andrew Ottaway
by Andrew Ottaway
0 Votes
Comments 1
Andrew Ottaway

When I was the medical director of the Trust we removed culture of bullying discrimination and racism and created just culture 1. We appointed kind caring compassionate leaders to each department 2. We made staff and patient engagement is the way we do things 3. We implemented good governance 4. We implemented duty of candour 5 We supported staff to speak up - 70 staff came to meet me in confidence 6 We took action and we protected staff 7. I had to dismiss few bad doctors and...

Umesh Prabhu
by Umesh Prabhu
0 Votes
Comments 3
Umesh Prabhu

A just culture in the NHS and social care will be created when we start to treat everyone as equal i.e. when we start listening without prejudice of who's reporting a safety incident regardless of the 9 protected characteristics. When we create a culture of inclusion, involvement and engagement with all staff groups without bias. My point is basically that we work with very diverse cultures and groups of individuals and we should respond to reporting in a consistent manner not based on who's...

Tabetha Darmon
by Tabetha Darmon
1 Votes
Comments 1
Tabetha Darmon

As human beings working in Health and Social Care we are often expected to not to make any mistakes, to attain an impossible standard of perfection which is unachievable and when we fail we are blamed and subsequently punished, which is not only unfair but is unjust. Fair and Just Cultures are about building an environment where staff feel safe, where patient safety is paramount and where real learning can take place after adverse incidents. To properly understand what creates an adverse...

Christine McGhee
by Christine McGhee
1 Votes
Comments 1
Christine McGhee

We should look to learn lessons from the work of Professor Michelle Tuckey - who has done extensive work and research in this area over the last ten years or so. Working with the healthcare, education and prison sectors in Australia, she has identified the critical aspects of bullying and harassment that link it to risk and identified tools and strategies to reduce that risk. Latest research highlighted here: https://www.youtube.com/watch?v=GWHlXH0kzJo

Paul Deemer
by Paul Deemer
0 Votes
Comments 3
Paul Deemer
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