Developing cultural change in healthcare: Part 2 – by Dawn Stott

Summary

In a two-part blog for the hub, Dawn Stott, Business Consultant and former CEO of the Association for Perioperative Practice (AfPP), talks about the strategies that can help you develop cultural change in your organisation.

In part one, Dawn set out the steps to develop a programme of change to support you to achieve good solutions. In part two, Dawn gives you tips on how to assess the culture of your organisation and establish a programme of standardisation.

Content

Establishing cultural change

To establish cultural change, it is important to firstly assess the culture within the service, particularly in response to incidents. It can sometimes be difficult to establish whether the current culture enables open and honest discussions at all levels among hospital teams and patients. Test this through open communication and internal audit and observation.

A cultural assessment can be an internal process whereby organisations evaluate their workplace culture. There are many tools available to support this type of evaluation; for example, Insights Discovery, My Team Radar, etc. It is statistically proven that the right behaviours within an organisation can enhance performance and wellbeing within a team. Cultural assessments generally analyse both the implicit and explicit beliefs and attitudes held by an organisation and by everyone involved. The outputs from the analysis should help leaders make informed decision about the current culture and determine if actions are necessary to strengthen the organisation and those who work within.

If a culture of openness currently exists, then to establish a programme of standardisation will be easier to achieve. However, if there is a lack of psychological safety within a team, then there will be barriers to change, and the programme of learning and education may take longer to achieve.

It will be important to consider the relationship between team members to determine if these enable them to work collaboratively, share responsibility and resolve conflict promptly and constructively – without blame.

Standardisation

When we talk about standardisation of a process, it essentially means that people working for that organisation have an established process to use. If standardisation is done well then it can decrease ambiguity about patient care and guarantee quality, boost productivity and support positive morale within a team. By standardising a process it will eliminate the need for guesswork or extra work.

Every task within any organisation, regardless of how often it is carried out, requires guidelines/rules that define the methodology that needs to be followed. If these rules are not standardised, then you can’t assess whether you are undertaking jobs effectively and ensuring a quality outcome. Standardisation also supports the reduction of human error. A standardised way of doing any task within the perioperative environment should be documented and used as a training tool for new employees.

An example of standardisation of care and change, without a mandate or guideline to follow, is the securing of a cannula. Before the most common way of securing a cannula – generally using a product similar to the 3M Tagaderm dressing – most practitioners would secure the cannula using tape and/or bandages. The driver to this change may have been around infection control issues relating to the use of tapes, which may have significantly transformed the change into an acceptable and standardised way of working.

Rules in the workplace are not only driven by policies and procedures. In many organisations, and particularly within healthcare, ‘rules’ are also established by patterns of behaviour or the ‘unwritten rules’. The ‘this is how we do it here’, type of approach can influence behaviour and expectations, often referred to as custom and practice.

In healthcare unwritten rules and ways of working can become deeply ingrained into the workplace culture and, if not managed effectively, can consequently seriously endanger patient outcomes.

Sphere of influence

As healthcare professionals you have a ‘sphere of influence’ in everything that you do. The example below shows a sphere of influence for airway management.

Essentially a clinician’s core sphere of influence is the care given to a patient allowing patients to make informed choices and support health equality. The WHO checklist is a great example of a core sphere of influence in that there is an obligation to act meaningfully to ensure the patient pathway through theatres is safe – it should not just be a ‘tick box exercise’.

Healthcare organisations have obligations to patients; however, these are not the same as those between patients and clinicians. Organisations have an obligation to provide structures that support healthcare practitioners to create a culture of integrity. By not upholding the organisation’s values they are compromising the integrity of the organisation and the long-term effectiveness.

If initiatives are implemented, they should be followed up and measured to ensure patients are getting the best possible care and employees are nurtured and reimbursed effectively for the work they undertake.

My advice would be don’t cut corners just because others say it is ok. Don’t watch others cut corners because then you are condoning poor practice and not working effectively within your sphere of influence. Ask yourself ‘what are the driving factors to cutting corners’, is it about time, saving money or something else? Work on ways to change things so patient safety is not compromised.

Change is always difficult to achieve because people become entrenched in their ways and their mindset is often ‘if it aint broke, don’t try and fix it’. However, if a product can be substituted that leads to better patient outcomes, then it should certainly be seriously considered.

NHS England says that:

"Patient Safety is the avoidance of unintended or unexpected harm to people during the provision of healthcare. We support providers to minimise patient safety incidents and drive improvements in safety and quality. Patients should be treated in a safe environment and protected from avoidable harm."

If you can drive forward on a patient safety initiative that supports better patient outcomes, then do so. Who knows, you may become a patient safety champion who advocates for better patient results. Also, remember, you or a member of your family may one day be a patient and you wouldn’t want somebody to be cutting corners or compromising your safety because it’s quicker and easier to do so.

About the Author

Dawn has worked in healthcare for around 30 years in many different roles.  She is a published author and a human factors/quality improvement consultant.  After 14 years, she recently stepped down from her role as AfPP CEO and is now – rather than putting herself out to pasture – pursuing opportunities that are her passion.

She has an all-round understanding of healthcare from primary care commissioning through to secondary care interventions.  Some of her previous roles have included commissioning new hospital and GP surgery builds, IT implementation programmes, customer care, team building and leadership training strategies. She also has a strong knowledge of charities and the legalities around running a successful and sustainable charity. Along with a colleague she has recently started a Yorkshire Charity Leadership group to support senior leaders in charities. From experience she knows it can be quite lonely at the top.

Since ‘retiring’ Dawn has also joined the British Association of Day Surgery as their Lay Member. She is looking forward to supporting their values and strategy. Her philosophy is that kindness is infectious and should be at the core of everything we do, kindness can support change and encourage growth for everyone around you, so BE KIND.