Director of Workforce Amanada Oates discusses Mersey Care's Just and Learning Culture policy

Just and Learning Culture: Update about our people practices

In every human system mistakes can occur. At Mersey Care, we know we operate in one of the most complex environments.

Creating a Just and Learning Culture is a commitment to our workforce and to our patients that our organisation will take every opportunity to learn and improve. Our aim is to create a compelling place to work, where we attract, retain and develop people to be the best they can be and deliver the best care.

Our next phase of work focuses on how we truly facilitate a restorative approach when things don’t go as expected. We should take preventative action to identify processes that exacerbate the potential for error, and most importantly, celebrate the abundance of strengths and successes that occur throughout our working day.

It's important to remember at the start of our Just and Learning approach in 2016, approximately four per cent of staff faced disciplinary investigations every year. This figure was even higher if you add the organisations Mersey Care has subsequently acquired.

Whilst over half of those investigations found there was ‘no case to answer’, we now acknowledge staff suffered as a result, as did the wider teams and even their families. Some people were suspended for long periods of time, subject to rumour and gossip of ‘no smoke without fire’. Exonerated and non-exonerated staff encountered hurt during the process, some physical or mental health problems, and career impact.

Some of our hurt was documented in a powerful film which was released as we started out on this journey. The film came from the academic and restorative justice expert Professor Sidney Dekker and can be seen below:

That journey began as a pilot as we worked collaboratively with our staff side colleagues and operational managers, initially in the secure services division. It was formally launched in April 2017 and then widened across the whole Trust. We have come a long way: there has been a 75 per cent reduction in disciplinary investigations since 2016 (including our pilot year) and 92 per cent reduction in suspensions. But we are on a continuous journey and have aspirations to do so much more.

We now recognise that saying a formal investigation, suspension or exclusion is ‘non-prejudicial action’ does not feel like that to the member of staff concerned. HR work tirelessly with operational managers and unions to keep investigations and suspensions to an absolute minimum. This is really important for their psychological wellbeing and safety. Alongside this we have developed improved access to occupational health, staff support services and resilience programmes.

There are other initiatives including our Supporting Colleagues Policy, Just and Learning ambassadors and specific training for band 7 managers and above. We’ve found that a number of policies and processes are not conducive to our Just and Learning and restorative approaches. At this month’s Trust executive committee, we’ll address these recommendations. In any large, complex organisation this will be the tip of the iceberg. We’ll continue to look at this to make sure our structures, policies and processes support not hinder our ability to do our best work.

As Director of Workforce, I know we still have some way to go but we are continually striving to learn and improve our people practices. We recognise that the old ways of identifying the causes of harm in patient care was often inhibited by a fear of being blamed by the very procedures in place to protect people. This does not detract from one of the Trust’s core values being: ‘Accountability’.

Accountability

Mersey Care staff are responsible and accountable for performing their duties, behaving in accordance with our staff charter and all our values. A Restorative Just Culture approach will help guide the organisational response in the aftermath of an incident or event. It will enable organisational learning by increasing our understanding of the impact of the incident and how to put things right. This approach really brings our organisational values and the Trust’s work on civility and respect to life.

Just and Learning Culture, post incident impact

We believe that for the vast majority of incidents, the formal disciplinary investigatory route is neither appropriate nor helpful to reduce the probability of future occurrences. It also places a considerable strain on our people and can create more victims and hurt.

By reframing mistakes as learning opportunities, it improves both the individual needs and the wider Trust. This may include reflective practices, supervision, training or performance and behaviour improvement. Although formal action may still be required in exceptional cases, this is never our preferred choice.

We have to acknowledge if a disciplinary becomes a way of shifting blame onto colleagues, we miss the systemic or organisational contributing factors. Critically we also inhibit the learning and therefore unintentionally disinvest in preventing further incidents.

 What’s next?

We have come a long way as a Trust but there remains more we can do. That said, I am very proud of the progress we have made and continue to make together. The work we are doing has drawn attention nationwide. Colleagues and I regularly present the Trust’s work externally and have been referenced in many national publications. We were described as ‘the gold standard’ when the ‘Being Fair’ Guidance Framework NHS resolution was launched at HSJ Patient Safety Congress this month.

The demand for us to share has led to the development of a four day Restorative Just Culture programme. We’ve done this in collaboration with Professor Dekker’s academic colleagues at Northumbria University. The pilot for the programme was delivered internally and has led to further learning and improvements.

A number of actions taken away included the development of a toolkit and one day programme to support our managers and staff to have restorative conversations and navigate historical barriers to doing so. These will help to cascade the techniques around restorative just and learning conversations with colleagues. Initially the sessions are for staff band 6 and above. We’ll be publishing the first dates for these shortly and we have also developed a short e-learning tool, to support colleagues in our own organisation and across the NHS which will be available soon.

Amanda Oates

Executive Director of Workforce