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Posted by Sarah Brown on 04 Apr '22

How culture going wrong impacts success and may cost lives

A toxic culture can be fatal and all-pervasive. Directly or indirectly, organisational culture can kill whether it is Boeing, Volkswagen, the police or an NHS maternity service.

a tragic and harrowing picture of repeated failures in care over two decades

Donna Ockenden – author of the report into Shrewsbury and Telford Hospital NHS Trust

I have been writing about this for years and for decades the Shrewsbury and Telford Hospital NHS Trust has had a “toxic”culture and values that has led to patients being ignored or blamed and a structure set up to fail. The inadequate training, too few staff, poor governance and the culture have led to 1,592 clinical incidents of poor care impacting 1,486 families. 201 baby deaths could have been avoided.

Deciding what is most important in any organisation is what sets the culture. The ranking of values where natural birth was seen as more important than a safe delivery or responding to the patients’ concerns was clearly part of the problem.

Values are more than the words

This tragedy prompted me to search for NHS values and I immediately found them as part of the NHS constitution and highlighted on the NHS recruitment website – the details below are taken directly from it (see source)

There are six values that all staff – everyone from porters, physiotherapists, nurses, paramedics and gardeners to secretaries, consultants, healthcare scientists and phlebotomists – are expected to demonstrate:

  • working together for patients. Patients come first in everything we do
  • respect and dignity. We value every person – whether patient, their families or carers, or staff – as an individual, respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits
  • commitment to quality of care. We earn the trust placed in us by insisting on quality and striving to get the basics of quality of care – safety, effectiveness and patient experience right every time
  • compassion. We ensure that compassion is central to the care we provide and respond with humanity and kindness to each person’s pain, distress, anxiety or need
  • improving lives. We strive to improve health and wellbeing and people’s experiences of the NHS
  • everyone counts. We maximise our resources for the benefit of the whole community, and make sure nobody is excluded, discriminated against or left behind.

Health Education England even has a free online tool to champion the values and behaviours of the NHS. The tool provides videos of staff working in various situations and asks questions about how you would have handled the same situation. People then get an assessment report to show you how they have done. On the page with the videos they further state

“All NHS employees share a belief in the quality of patient care. We call these beliefs our 'Values'.

It is important that our shared values are part of everything we do to ensure that our role has a positive impact on patient lives.”

Interestingly the videos are only for healthcare assistants, reception staff, back office and estates, not nurses and doctors who obviously should understand the values as part of their training.

Knowing someone who has recently been appointed as a GP receptionist she certainly had training that included the values but they were not ranked into order of priority.

For patients and the people who use NHS services, the NHS Constitution reiterates that:

  • the NHS provides a comprehensive service, available to all
  • access to NHS services is based on clinical need, not an individual’s ability to pay
  • the NHS aspires to the highest standards of excellence and professionalism
  • the NHS aspires to put patients at the heart of everything it does
  • the NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population
  • the NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources
  • the NHS is accountable to the public, communities and patients that it serves.

How did it go so wrong

Well, I think the list above illustrates the problem. It is too much to remember and gets lost in the practicalities of work. In fact, the NHS has tried to find a focus with "Care is our Business" and even has a logo. This might work if the staff believe they will be supported by senior management if they apply it as a value.

Values only translate into behaviours and the culture you want if failure to meet them is identified and condemned. For Shrewsbury and Telford, the Care Quality Commission (CQC), the independent regulator of all health and social care services in England, as late as 2018 rated the trust as “good” on the question of whether its services were caring. How can that be?

The message it gives to anyone in the staff who is doubting what is going on is that they are wrong.

Every organisation needs an ethical audit

The CQC should be audited themselves as it seems that maybe they are failing, but who audits the auditors? Staff need to know that failure to meet values is important and will be found out.

If you want an ethical audit that helps you identify any cultural issues and whether your values are really being translated into behaviour, then we can help. Give us a ring or learn more here.

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