How does it feel to work in a toxic culture and what impact it has on patient safety

We know that blame and fear is toxic. It makes working in healthcare unsafe for staff and is a huge barrier to patient safety - staff won’t share what goes wrong if they expect not to be listened to or worse, will be criticised or blamed for errors that are really attributable to unsafe systems. It would be really valuable to better understand how this feels and the impact it has on clinicians and the safety of patients and service users. 

1 hour ago, HelenH said:

We know that blame and fear is toxic. It makes working in healthcare unsafe for staff and is a huge barrier to patient safety - staff won’t share what goes wrong if they expect not to be listened to or worse, will be criticised or blamed for errors that are really attributable to unsafe systems. It would be really valuable to better understand how this feels and the impact it has on clinicians and the safety of patients and service users. 

Good point Helen,

If anyone would like to contact me with either a blog or a case study on how this has impacted patient care, I would be willing to help them on this  [email protected] 

Unsafe systems are a human factors issue, a fact long-recognised elsewhere in sectors with a public-safety remit. Confidential staff-engagement/human factors dialogue/whistle-blowing platforms have been around for decades in industries such as aviation, rail, maritime and road transport, and work very successfully in raising, resolving, and understanding the impact of these issues. There are a number of web-based programs and smartphone 'apps' on the market that improve the way staff can raise issues without the fear of detriment for displaying the integrity to want to resolve a problem, within a health- or social-care setting. 

Hi Andrew,

I would be interested in the apps.  I have one on my phone that I have started to use called spotlight.  Do you have the names of the other apps I could try?

Hi Claire. A number of Trusts have their own specific 'app' - UHMBT for example - that can be downloaded from Google Play or Iphone app store, and there's also Improvewell. Trusts I've spoken with are sceptical about 'apps' for a number of reasons; you have to hope that your staff are willing and able to download software to their personal devices, and there are concerns - real or imagined - about how the software interacts with programs like location services or files on your device. If you're looking for a platform that gives an 'app-like' experience, but one that uses your inbuilt web-browser on your phone, tablet, laptop or PC, there's WorkInConfidence. https://www.workinconfidence.com/ is cloud-based (ie it sits on the client's own purpose-built website on a secure server) but does more than just facilitate raising workplace issues.

hi Andrew,

i have just had a look at the link you sent - I have a meeting with the safety team at my trust tomorrow - Im going to show them this.  Im liking the 'speaking in confidence part.

thank you

6 minutes ago, Claire Cox said:

hi Andrew,

i have just had a look at the link you sent - I have a meeting with the safety team at my trust tomorrow - Im going to show them this.  Im liking the 'speaking in confidence part.

thank you

Hi Claire. I've attached some information on WorkInConfidence that might be beneficial. 

WorkInConfidence.2019.07.04.All.NHS.pdf

There is a bigger issue at play, beyond the requirements of NHS Trust staff to have a suitable platform for raising these important issues; Sustainability & Transformation Partnerships and Integrated Care Systems in England, and their counterparts in Scotland and Wales include employees of local authority and private social-care providers who currently have no equivalent to the Freedom To Speak Up Guardian system, let alone a communication platform.

WOW, I had no idea bout that

Me neither @Andrew Ottaway. That's shocking

@Claire Cox I wonder whether we should tweet this as well and ask for contributions? If we are truly to work as a integrated health and care system, then having different protections and support systems just doesn't feel right

I think its also important to think about how the "toxic environment" burn the people out who end up trying to manage it--on both the sharp and the blunt end. This 1999 article from the Harvard Business Review is one of my favs on that topic: https://www.ncbi.nlm.nih.gov/pubmed/10539211  The full text should be free with registration https://hbr.org/1999/07/the-toxic-handler-organizational-hero-and-casualty 

Hi Lorri, I hadn't read that article before. It's brilliant and spot on! Thank you

There was an organisation where I eneded up as a 'toxic handler' thought I didn't realise that when i joined. It was the only role that I left without another to go to. After two years, I just couldn't take it anymore!

@Claire Cox We defeinitely need to add to the hub

I think this is an unexplored area that affects "blunt end staff" -- a lot. Granted, they aren't "laying of hands" and their burnout and bullying may not as directly affect clinical safety, but it does signify the lack of a safety culture. If we profess to fix the entire culture to enable safety--health care needs to see the negative impacts on non-clinical staff both in clinical and non-clinical environments as well. 

This is another good one: https://doi.org/10.1016/j.jsr.2017.12.015
  

civilitysaveslives.com

Hi @Sarah Clerk thank you for sharing the website address. Are you able to give a bit more information around the work of the organisation and why people following this thread may find it useful? 

What is Civility Saves Lives? 'We are a collective voice for the importance of respect, professional courtesy and valuing each other. We aim to raise awareness of the negative impact that rudeness (incivility) can have in healthcare, so that we can understand the impact of our behaviours.'

@Patient safety Hub If you go on the site, they reference in their tweets quite a lot of resources including videos. Would be great to get these all on the hub

Here are some resources we have on the hub now that look at workplace incivility and the impact that rudeness can have on patient safety. This includes a really interesting TEDx talk from Chris Turner who founded Civility Saves Lives.

TEDx: When rudeness in teams turns deadly (Chris Turner)

The impact of rudeness on medical team performance: a randomised trial

Make or break: incivility in the workplace

BMJ Quality & Safety: Exposure to incivility hinders clinical performance in a simulated operative crisis

And a news article from Nursing Notes:

Nurses need to be kinder to each other or patients will be negatively affected, warns Senior Nurse

Below is another link to an incivility resource and also a fact sheet that highlights some of the issues incivility can cause and how these can impact patients. 

Civility Saves Lives – the impact and importance of civility in the workplace