in spite of all the noise around them. They can also expect to enjoy significant rewards. A culture of openness, for example, has been associated with demonstrably lower mortality rates among 137 NHS acute Trusts, and organisations regularly achieve a 6.48% reduction in mortality events following culture initiatives.7 Meanwhile, improvements in culture could easily represent a 30% reduction in the £2.2 billion litigation costs through NHS Resolution, saving around £660 million every year.

Focus on what you can do, rather than what you cannot

At first sight, the challenges facing healthcare leaders today appear overwhelming, so what can executive teams do to overcome the numerous barriers to success and how do they cope during extreme circumstances? ‘Focus on what you can do rather than what you cannot’ is a good place to start the journey towards a new and enlightened workplace culture. Here are six strategies to consider:

Deploy systems that allow you to hear what your team is telling you: Establishing an open culture has to be based on the ability for leaders to understand the organisation they are managing. Sydney Finkelstein’s book, Why Smart Executives Fail, highlights the outcomes of once-great organisations that were managed by leaders who did not work in the same reality as that of their teams.

Eliminate the fear factor: Your organisation has to be open to hearing the truth from all staff. Nothing is worse for communication than a healthcare organisation where bullying and harassment are rampant. The statistics speak for themselves. When you

A culture of openness has been associated with demonstrably lower mortality rates among 137 NHS acute Trusts, and organisations regularly achieve a 6.48% reduction in mortality events following culture initiatives.

take into account the direct specific impacts to staff health, sickness absence, costs to the employer, employee turnover, diminished productivity, sickness presenteeism, compensation, litigation and industrial relations costs, bullying and harassment are estimated to cost the taxpayer £2.281 billion per annum – and that’s a conservative estimate.8

Executive teams should focus on eliminating the fear factor so that if an individual has been diligent, but still has no success, it’s not the individual’s fault but the organisation’s fault.

Change unsuccessful leadership habits: identified as an important step to success in the book ‘Why Smart Executives Fail’. The key is to listen and to be open to changing your leadership habits based on feedback from your teams. Put another way, seek to become a ‘servant leader’. A servant leader is one that focuses on building systems and processes that enable their people to flourish in their roles and to be the very best that they can be – and then gets out of their way. To use a lesser known quote from Albert Einstein, “Do not try to become a person of success but try to become a person of value” – in the terms of leadership, this means be of value to your staff.

Caring for your staff is not only based on ethical and professional values of good healthcare, but research suggests it is a key

differentiator of successful organisations in all industries. For example, supporting staff where failures happen and taking ownership for improving the system. Executive leaders should aspire to attain the top ten characteristics of servant leadership: listening, empathy, healing, awareness, persuasion, conceptualisation, foresight, stewardship, commitment to the growth of people and building a community.

Visibly own inspiring visions and culture: operationalised at every level with clear, aligned objectives for all teams, departments and individual staff. This is something most organisations have, but only the best organisations’ leadership teams actually live by them, every day. A vison can just be a set of words on a slide, but when an organisation’s leadership team truly believes and exhibits this belief in an inspirational vision it has the power to remove stress. The tangible value of this is evidenced in a growing body of research on how stress reduces an individual’s ability to acquire knowledge and understanding through thought, experience, and the senses.

Adopt a just culture: in a sector where a blame culture is prevalent, the greatest stressor for staff especially during a healthcare crisis like COVID-19, is ‘What will happen to me if something goes wrong?’ The first step towards positive cultural change is to eliminate blame by focusing on the systems or processes that support staff rather than the supposed failings of individuals. Avoidable deaths (the Office for National Statistics deems some 22% of deaths to have been avoidable9

are often caused by

inefficient processes. Be mindful of the system, consider its impact on staff and a just culture will follow. A just culture aims for openness and transparency: if transparency were a medication, it would be “a blockbuster”, with billions of dollars in sales and accolades the world over.10 Indeed, NHSE’s definition of a just culture is one that supports fairness, openness and learning in the NHS by making staff feel confident to speak up when things go wrong, rather than fearing blame.11


leaders can create a workplace environment where staff are encouraged to be open about their own mistakes, as well as the


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