and inflexible guidelines around what staff can and cannot do leaves people feeling unable to intervene to improve system safety and likely to avoid involvement for fear of repercussions.

Take inspiration from the grieved and bereaved

The irony is that most people who have suffered grief and bereavement following the death of a loved one in hospital or in a care home are actually more concerned with ‘what happened and why?’ rather than ‘who is responsible?’.

This is based on patient and public feedback to NHS England and NHS Improvement. However, the unfortunate reality for many doctors, nurses and other clinical staff is that they are victims of an active blame culture where individual practitioners are held accountable for system failings over which they have no control. This is bad for staff, bad for patients and it reduces the likelihood that the bereaved will be given the answers and closure they deserve.

What makes a just culture? To redress the balance, NHS England and NHS Improvement have published a guide that advocates a ‘just culture’. A just culture is fair treatment of staff that supports a

The unfortunate reality for many doctors, nurses and other clinical staff is that they are victims of an active blame culture where individual practitioners are held accountable for system failings over which they have no control.

culture of fairness, openness and learning in the NHS by making staff feel confident to speak up when things go wrong, rather than fearing blame.4

Supporting staff to be open

about mistakes allows valuable lessons to be learnt so the same errors can be prevented. Another way of considering a just culture is to be guided by the five principles of FREDA (Fairness, Respect, Equality, Dignity and Autonomy).5

These form the basis of all

international human rights treaties and are today used by the Care Quality Commission (CQC) to regulate health and social care services. Along with the mission of the healthcare sector, which is to preserve the human right to life, we should be making the rights of staff equally sacred.

Seven key elements for the transformation to a just culture Leadership teams who are focused on

addressing staff welfare need to include the following elements in their thinking and in doing so will make significant progress in building an open and just safety culture:

l Adopt a ‘human rights’ approach: To overcome the blame culture. Follow the lead of the CQC. Today, the CQC aims to regulate all health and social care services using the five guiding principles of FREDA (Fairness, Respect, Equality, Dignity and Autonomy), principles that can equally be applied to the workplace.

l Systems not people: Concentrate on the systems or processes that support staff rather than the supposed failings of individuals. As James Reason proposed, avoidable deaths are often caused by inefficient processes failing to remove or reduce the risk of error. It’s every healthcare organisation’s fundamental duty of care to staff to lead and review opportunities to improve on this premise.

l Lead from the front and with compassion: Create an open and transparent environment where staff feel valued and flourish, leading to greater collaboration and positive outcomes for patients. Encourage staff to instigate positive change, learn from success as well as mistakes, make time to communicate change and help staff understand the reasons for change. Be visible, open and demonstrate a will to learn; all are essential traits when dealing with the transformational impact of COVID-19.

l Empower staff: Enable and support staff with higher levels of autonomy supported by systems and processes designed to track, evaluate and support positive change. Supporting this culture with acknowledgement of excellence and open accessible processes for supporting change will encourage staff to take opportunities to make positive change when they arise.

l Focus on what you know can improve: Healthcare organisations should encourage positive action by being transparent on which issues they are tackling at an organisational level and why. Organisations should look to avoid wasting energy on speculative or large sweeping changes, especially during a crisis. It is also important to communicate with staff, being honest about what the organisation is and


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