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Include NHS workplace culture in formal performance targets, says report

This should be measured just like finances or A&E waiting times, recommends change culture specialist firm

Caroline White

Wednesday, 06 February 2019

NHS workplace culture should be measured by the healthcare regulator, the Care Quality Commission (CQC), just like any other performance target, suggests a report* published by change culture specialists, Pulse UK.

There are stark trends in the workforce culture of the best and worst performing hospital trusts, says the report, which draws on the findings of CQC inspection reports and NHS data.

Its analysis shows that staff at hospital trusts rated as ‘inadequate’ by the CQC are 20% less likely to believe their trust prioritises patient care than staff at trusts rated as ‘outstanding’.

And staff at ‘inadequate’ trusts were also 20% less likely to recommend their organisation as a place to work or receive treatment than their peers at ‘outstanding’ trusts.

What’s more, these staff were also less confident about reporting unsafe clinical practice and less likely to find the procedures for reporting unsafe clinical practice fair or effective.

“While the NHS has become safer overall, a blame culture persists. There must be consequences where neglect or deliberate actions have caused harm, but our reliance on negative feedback discourages staff from being accountable,” says the report.

“[We have] seen that the way in which a trust views and responds to complaints is a significant and essential factor in turning around a trust’s performance. Rather than seeing complaints as an administrative burden and something that should be defended, trusts need to view such feedback as a genuine opportunity to improve.”

With culture set to be central to the forthcoming NHS national patient safety strategy, the report calls for NHS trusts to measure and report their culture in the same way they would report their finances and A&E waiting times to NHS Improvement or the CQC.

“If ever there was a time for NHS providers, arms-length bodies and everyone across the health sector to ‘get serious’ about workforce culture, it is now. We are calling on the system to stop confronting the symptoms of poor culture and start tackling the systemic route causes,” commented Dennis Bacon, executive chairman at Pulse UK.

The analysis also found notable trends in leadership and strategy, with CQC inspectors citing supportive and cohesive leadership teams, and a unifying vision and strategy, as central to the success of ‘outstanding’ trusts.

‘Inadequate’ trusts, on the other hand, tolerate high levels of risk to patient safety and suffer from a workforce disconnected from the trust’s vision, the report found.

Another significant challenge facing the NHS is the growing turnover of trust executives, highlights the report, which calls for NHS leaders to be given adequate time to implement change programmes.

Quick fixes take precedence over getting to the root cause of why a trust may be struggling, it suggests, citing an example of a trust where NHS Improvement permitted more time to affect change by focusing on its culture, rather than forcing it to adopt a more conventional approach to improving performance. This has already resulted in significant improvements in key areas, it says.

“We can all think of too many cases where a trust in special measures has been ‘turned around’ in the short-term, only to fall back into problems because the underlying issues – culture, behaviour and leadership – have not been effectively addressed,” added Patricia Hewitt, chair of Norfolk and Waveney Sustainability and Transformation Partnership and a former health secretary.

“Unless these are tackled through a focus on workplace culture, we will continue to see adverse effects on quality, safety, sickness, retention and productivity,” she said.


* Culture in the NHS: Pulses report 2018. A report prepared by Pulse UK, February 2019.

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