We have seen the problems caused by a wrong culture within the banking industry (LIBOR fixing) and within the media industry (phone hacking). We have also recently had a powerful reminder that the wrong culture in healthcare can lead to a drastic reduction in patient safety and quality of care.
The Francis report has shone a spotlight on the attitudes and actions of staff in one small part of the NHS. The report makes for uncomfortable reading for all of us. The accounts of appalling lack of care are so shocking and difficult to equate with our core principles as health professionals, that it is easy to feel a sense of distance from them.
But we all have a responsibility to face up to the risks inherent in the system that contributed to the crisis investigated in the Francis report. How can we ensure that this never happens where we work?
For me the first step is to ensure an environment and culture which actively encourages safe practices. We need a ‘just culture’ based upon the principles of fairness, quality, transparency, reporting, learning and safety.
These principles create an environment which balances accountability and learning. It empowers staff to speak up when there is a problem, creates a place which is rewarding to work in and enhances the quality of service to patients – leading to improved patient safety.
But how do we achieve this just culture? We have to all commit to its principles of openness, fairness and learning. We have to create legislation, regulations, policies and procedures which support and encourage these principles.
In 2011, the Royal Pharmaceutical Society established its “just culture” initiative which gives guidance on how to embed these principles into the heart of an organisation. We have also supported our members in this with advice, in partnership with Public Concern at Work, on whistle blowing and access to a dedicated whistle blowing helpline.
However a just and safe culture are simply words on paper if they are not ‘lived’ in actions and interactions. We all have responsibilities for living the culture and embedding the habit.
In all our actions and decisions, we should be asking ourselves, is this just? Is what I am doing or what I am doing on behalf of my organisation aligned to a just culture?
Professionals must feel able to speak up about concerns, and feel accountable for their actions. A culture which understands and promotes the professionalism of its staff is one in which the patient will always come first.
For more information on the RPS and its work to embed a just culture in healthcare, visit www.rpharms.com
‘Achieving Peak Performance’, a white paper from 1000 Lives Plus, describes the essential elements for creating a just culture.