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.

As Mersey Care has expanded and continued progress towards a truly restorative just culture, we have welcomed the world-renowned expert in restorative justice, Professor Sidney Dekker, with us on a number of occasions. He has spoken to staff and spent many days in services. Sidney has written extensively on Just Culture and was keen to come to Mersey Care to see how we are doing. He now describes how Mersey Care was one of the first large organisations to progress these ideas.

In 2022, Joe Rafferty, Amanda Oates and Sidney Dekker edited a book “Restorative Just Culture in Practice”. It provides an overview of principles and practices. For Mersey Care, it describes in detail our first steps towards culture change some years ago, how the Trust Board and wider organisation came to adopt it and the major and minor changes to policies and practice required. It also sets out the outcomes and benefits so far. Colleagues, including external experts by experience and leading academics, contribute chapters about their experiences with the NHS and other organisational systems, and what still needs to be done.

In the book, Prof Rafferty and colleagues say:

“In the wake of an incident, restorative practices ask who are impacted, what their needs are and whose obligation it is to meet those needs. Restorative practices aim to involve participants from the entire community in the resolution and repair of harms to create a sustainable just, restorative culture.”

This is not a task and finish process. Culture change like this, though beneficial, takes time and requires the full and committed support of the whole organisation. In Mersey Care’s videos, books, lectures, and most importantly in our practice across a large and expanding trust, we set out how far we have come, what the benefits have been to staff and our ways of working, and how much more there is to do.

dekker.jpgWe 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?

It is our ambition that all our 12,000 colleagues, our patients and service users, all 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.

As our work continued, colleagues ran a number of work streams to embed our culture across our expanding services, each reporting to the Trust’s Chief People Officer. We worked to remove pejorative language from Trust policies, create links to academic research and deliver meaningful training to colleagues and wider partners. The effects of these changes can be seen in recent NHS staff surveys and other measures of our performance.

One very active area supported development of a respect and civility agenda. This has been shortlisted for several national awards. You can watch a short film about the issues we looked at. The group was formed from a diverse range of colleagues with broad experience across our services and sites created a practical tool to aid some of the most delicate staffing conversations. This is a two sided wheel device, offering alternative approaches to dealing with difficult conversations in the workplace.