Surely positive and proactive actions – not punitive practice – must undergird our culture change | Angela McNab

hospital staff in discussion

Since my last blog on our journey to achieve culture change, it’s been a pretty bumpy ride for our trust, and probably for others! Daily communications put the spotlight on NHS services and commonly draw attention to 'failures' of some kind.

On top of these criticisms, we have had two quite difficult incidents in our trust – one where an in-patient attempted suicide and another where a patient on a specialist unit received extremely poor care. Now one year on, the latter incident received significant press coverage which focused on regulatory action taken against staff and a keenness to apportion blame.

Here is the challenge: we are trying to establish a culture of compassion that provides consistent care to patients, and we expect to hold to account anyone who wilfully fails to deliver that. But we recognise that openness, learning and improving will not happen unless we work together and treat each other compassionately too.

If we are going to radically step up in terms of openness – speaking up when we see something that is not right, immediately responding to a complaint and seeing every action that goes wrong as an opportunity to improve – then surely we must change our attitudes to such incidents across the sector and in public.

I (occasionally) feel battered from all sides as I try to raise standards and build a positive culture; how much more must my frontline colleagues feel so? Yet we know that we perform our best when encouraged and recognised positively, not when we are criticised and put down. With this in mind, my clinical cabinet leading the culture programme has insisted we don’t only have a 'concerns' button on our intranet for staff to report issues but a 'fanfare' button too to report and share our good practice.

To try and live out the culture of value and learning, I wrote to my staff involved in the attempted suicide before any investigation (or criticism) and thanked them for how they dealt with the incident itself, irrespective of any failing that may or may not have led to it. I applauded their reaction which helped save a life and thanked them in advance for the learning that I knew would follow. I visited the staff on the specialist unit where we had found  poor care, to acknowledge how they had worked openly with families to address concerns and create a centre to be proud of.

As we plan staff awards now for this year, we are instigating a new award for the team who can show how they learnt most from an incident or complaint they experienced. If such awards were commonplace in the national arena (and the entries high!) this might start to create – nationally – the culture we all want to see. It might even encourage the health journals to report incidents through a positive lens. How about it – let's acknowledge that as human beings we do our best but sometimes fail, and the ideal culture is one that supports people through that and into delivering the highest standard of care.

Angela McNab is chief executive of Kent and Medway NHS and Social Care Partnership Trust. Follow the trust on Twitter @kmptnhs.

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