Since the year dot people in the healthcare policy world have written about the need for a learning organisation – I may even have been one of them! And, of course, when things didn’t work out the way we’d planned and there were investigations, how many times would we read in NHS reports and the press that ‘lessons have been learned’, but incidents would happen again and again. We would reach that point where the organisation loses control and there would be demands for a head on a pole. In short, we’d end up in a spiral of blame culture.
We were fortunate to be introduced to Professor Sidney Dekker a couple of years ago. Since then we’ve begun to explore the whole idea, not of a ‘no blame culture’ but of course a ‘just culture’. We’ve listened hard to what Sidney has said and, as a respected academic, he brings a lot of international experience and data to his thesis. But for us, this isn’t a science, it’s experienced learning. In fact, listening to our staff, we’ve even called it something different – our Just and Learning Culture.
As a result, we’re making an open attempt to make sure we do things differently. Things are starting to happen in Mersey Care, things are changing so that it really does feel different. You’ll have read how we’ve changed when it comes to disciplinaries, but we’ve also started to change the conversation throughout our organisation.
We’re two years into this and I still have to think hard about it. I’ve been in senior leadership for 20 years in the NHS but I don’t think that until recently, I’ve ever had a conversation anywhere where someone had said to me ‘you need to think about it this way’. As an organisation we’ve made a huge commitment to continuous improvement and always want to do more and always want to do better. It’s hard because it needs leaders to think differently about how they run organisations, for managers in how they deal with their staff – and all of us in how we respond when things don’t go as expected.
Photos - After visiting Mersey Care in 2017, Professor Dekker returned last month to visit wards, talk to staff and service users about Just Culture.
The culture has to go right through. Many of you will recall that Professor Dekker visited Mersey Care last summer. This week, he’s been visiting services to see for himself how we’re rising to this challenge, responding directly to those ‘Bids for Sid’ many of you made recently.
Sidney has been to Ashworth and Clock View hospitals, Whalley and Sefton, meeting not just the ambassadors but staff on wards and, importantly, many service users. He began on Monday in Scott Clinic and heard that the NHS way when something went wrong was to introduce more paperwork. Similar examples came from across our divisions. In Sefton, a member of staff told him that, from a HR point of view, we need to change from knee jerk reactions and root cause analysis to giving staff an environment and confidence to talk to us.
As well as being shown around our secure wards by service users, I joined carers, governors and those with first-hand experience of our care at the Life Rooms in Walton. Sidney explained to the meeting what a Just and Learning Culture means for them. I was proud to hear how far on he believes we are when compared to many of the organisations and public bodies around the world he’s worked with. He said some of what we do with coproduction was unique. As ever, the stories we heard were humbling and inspiring, and provoking too. We need to get the culture right for our staff and absolutely for those we are all here for.
It’s been a great week and I want to thank everyone who has helped to shape it so that the Professor could see us and really get chance to hear from service users and staff directly and honestly. The efforts of the organisers, speakers, plus the support of staff side, our colleagues in Liverpool Community Health and many others have enabled us to have a really successful visit from an experienced critical friend, who is able to support and challenge us.
I will share with you Professor Dekker’s final views and thoughts as he leaves his week in our services. These are just my thoughts on what I’ve learned over Sidney’s two visits to Mersey Care. The next big step we must all take is for this to be owned by each and every one of you.
To finish, there was one comment this week that rang most loudly: someone said that we’ll know we’ve really embraced our just and learning culture when we don’t need to call it that. It will just be Mersey Care’s culture.