HSJ Award spotlight: implementing a Just and Learning Culture

The below has been quoted from the Care Quality Commission (CQC) website:

Mersey Care NHS Foundation Trust wanted to develop a supportive culture where workers feel safe to speak up, report errors and learn from incidents.

Workers felt that there were barriers in the HR and patient safety processes. Trade union colleagues were concerned about the detrimental impact of these processes and that staff didn’t speak up because of perceived consequences. 

Equally, NHS Staff Survey results confirmed concerns that fairness of procedures were below average. The trust also needed to tackle the high number of employee relations cases which was perpetuating this fear.

To overcome these challenges, the trust delivered engagement sessions with staff and unions to help them understand the barriers workers faced and sought alternatives together.

At the same time, the trust’s Chief Executive, Workforce Director and Medical Director researched the evidence around ‘Just Culture’.

The trust found that whilst workers strongly supported the ideas behind a ‘Just Culture’, they wanted to make it their own, feeling that they should add a learning aspect to ‘Just Culture’. 

Amanda Oates, Executive Director of Workforce  at Mersey Care NHS Foundation Trust (pictured above), said, “Our work to embrace a new culture centres on the desire to create an environment where staff feel supported and empowered to speak up, rather than feeling blamed. It’s a culture that instinctively asks in the case of an adverse event ‘what happened’ rather than ‘who was to blame.’”

She said, “Engaged staff delivering best quality care is at the heart of what Mersey Care does, helping us strive towards our vision for Perfect Care. The success of the disciplinary investigations pilot was expanded to all trust divisions in 2017. Overall investigations and employee relation cases were reduced by 59 per cent trust-wide, whilst their workforce doubled.

In April 2017, Chief Executive Joe Rafferty, alongside Medical Director Dr David Fearnley and Amanda Oates agreed three priorities in consultation with staff. These were published in the Trust Quality Accounts and demonstrated that commitment from the highest levels of the organisation. 

The benefits included establishing an accessible staff microsite where good practice stories are shared and also recruiting nearly 50 ‘ambassadors’ - frontline staff from various locations - to lead bespoke practice. A roadmap booklet of the trust’s journey has been shared widely internally and externally.

A critical part of the tendering process and winning the contract for Liverpool community services was around staff and patient safety issues, highlighted in the Kirkup Report. The Just and Learning approach was key to the award of this contract by NHS Improvement, and was vital to the transformation of those services.

Other examples shaped through employee engagement included the development of a policy framework that supported workers when things do not go as expected and significant improvements to the 72-hour review process. As a result, colleagues now receive consistent and timely feedback with enhanced shared learning.

Paul Summers, Unison North West Regional Organiser, said, “The Just and Learning Culture introduced by Mersey Care in partnership with local staff side unions has seen amazing outcomes with a huge reduction in the number of disciplinary cases, improved staff morale, health and well-being and importantly improve patient care. 

“This is the best example of partnership working that I have been involved with and Unison commends Mersey Care NHS Foundation Trust and hopes other employers will adopt such practices.”

Amanda added, “Mersey Care employs more than 8000 staff, supporting some of the most complex and vulnerable people in society. Changing the organisation’s culture will take time but people are already feeling empowered. We frame our conversations differently and support each other more. We are in a much better place for making those steps towards a Just Culture.”