Mersey Care is committed to delivering Perfect Care

This depends on the development of a Just and Learning Culture. The widely reported mistakes in some NHS organisations were not helped by reluctance amongst employees to report those mistakes. That reluctance came from concern about what the personal consequences might be. It also comes from the concept that investigations often tend to see human factors as the cause of the mistake, seeing people as the problem, assuming that because we have policies and procedures in place things won’t go wrong and if they go wrong people are blamed.

Internal research found barriers to transparency included fear, blame and shame. Staff and staff side colleagues started to ask, quite rightfully, about a zero blame culture. That in itself was an indication that we had made a change in thinking as it is only by promoting openness and transparency that we will accelerate our rate of improvement.

We’ve learnt from established academic works, in particular by Professor Sidney Dekker, author of best selling book ‘Just Culture’. We’ve looked at industries like airlines, nuclear technology, oil and exploration and some healthcare in the US, all of which go about their daily business knowing there is always an element of risk. There is a very poignant example of how difficult this move can be captured in the true story of “Sully”, made into a film starring Tom Hanks. It focuses on the pilot Captain Chesley Sullenberger, who famously made an emergency landing on the Hudson River in New York. His actions saved all the 155 passengers and crew. Despite being a national hero, he was later investigated by airline authorities.

Mersey Care’s work to embrace a Just and Learning Culture has centred on the desire to create an environment where staff feel supported and empowered to learn when things do not go as expected, rather than feeling blamed. This is a culture that instinctively asks in the case of an adverse event: “what was responsible, not who is responsible”. It is not fingerpointing and not blame-seeking. But it is not the same as an uncritically tolerant culture where anything goes – that would be as inexcusable as a blame culture.

  • 100 percent of leaders Band 7 and above and equivalent have been assessed and have a development plan to support their teams in a Just and Learning environment
  • To support colleagues’ psychological safety through the development of bullying awareness for staff based on a preventative approach to recognise bullying behaviour and development of a process to resolve issues
  • To develop a standardised framework to support learning from incidents including supporting staff, how to debrief effectively, and to provide governance and validation mechanisms to improve the safety and experience of the people we serve and our colleagues so that risks are addressed and learning is maximised
  • Produce a guide for colleagues and service users on Just and Learning expectations to describe the shared responsibility between individuals, teams and the organisation to create a safe and compassionate environment.

dekker.jpgWe were delighted to welcome the world-renowned expert in restorative justice, Professor Sidney Dekker, with us for a week. Sidney wrote the book on Just Culture and was keen to come to Mersey Care to see how we are doing. 

We ensure that in our daily practice, our conduct and our dealings with colleagues is honest, kind and willing to learn. Of course, a Just and Learning Culture is much more detailed than that, but asking yourself if you are those three things is a really good check for starters. Are you helping to shape the culture in your team or ward with your positive attitude or willingness to help?

We want to ensure every one of our 8,000 colleagues, along with our service users, understand and feel a true part of our Just and Learning principles. Alongside our Freedom to Speak Up Guardians, our HR team, our fantastic Just and Learning Ambassadors and our staff side, patient safety and Centre for Perfect Care colleagues, we are now developing plans to introduce a ‘pause’ process for colleagues who feel things in work are not going as they had hoped.

We have a number of work streams to embed our culture across our expanding services. Our development of a respect and civility agenda has been shortlisted for several national awards. You can watch a short film about the issues we want to address here and see how we’ve created a practical tool to aid some of the most delicate staffing conversations here.

We’ve developed free online training aimed at HR staff but accessible to all in the sections below.

We tell the story of what happened in one NHS trust, Mersey Care. We look at how being a rules based organisation meant there was a lack of awareness of the psychological harm of some HR processes.

Click here for module one

In the second module we acknowledge that mistakes can and will happen.

Click here for module two

Click here for module three

In the third module we hear that a Just and Learning Culture must have the full commitment of the Board of Directors, and senior leaders and influencers answer your questions.

In Module 4, our staff role play a real life upsetting situation – can you help them?

Respect and Civility has never been more important; being polite, courteous and respectful, and treating everyone with dignity and respect and according to their individual needs should be the standard but with the internal and external pressures sometimes this can be lost.

The training package highlights the importance of behaviours to equip staff with the necessary confidence and tools to speak up if they witness something they think is not right #IWillSpeakUp.  The training gives examples of best practices, which will hopefully reinforce areas staff are already doing well in.

Click here for module four