Rapid Literature Review: The characteristics of safety cultures (CQC, 26 July 2023)

Summary

Safety is important to how CQC regulate services. During inspections, the Care Quality Commission (CQC) wants to know how safe the care is that is being delivered.

The topic of safety culture is complex. There are different ways to define it. Safety culture can look different in different places. Therefore, it has been the subject of lots of research. This report carried out by RSM UK Consulting LLP aims to summarise previous research. This can then help CQC to think about how to regulate in a way that reflects the simple basics of safety culture.

Content

Findings from the literature

1. What are the key characteristics of good safety culture, how do these develop and how can these be defined?

There is no one definition of what good safety culture is. This is because it is complex and can change quickly. We have chosen to discuss five features for this report. These summarise key features of good safety culture and include:

• Behaviours of staff. This means teamwork and trust between people;
• How people communicate. This means how people talk to one another;
• Psychological safety. This means how safe people feel to speak up;
• How organisations work. This means people having the same goals; and
• Involving those who use services. This means listening to the voices of people who use services to help make decisions.

2. What are the enablers and barriers to developing and sustaining good safety culture?

Factors that can help to support good safety culture include:

• Leaders who are open to feedback so teams feel that they can speak up;
• Ways of working where everyone can express their needs and have their voice heard;
• Having mentors and chances to discuss safety more informally;
• Having ways to report when incidents occur and learn from them; and
• Using measures to understand more about ways of working, including staff experience.

Factors that can hinder good safety culture include:

• Staff tiredness from shift work;
• Staff members feeling that there are rules being imposed on them;
• A lack of clear expectations, responsibilities and standards;
• High staff turnover that means that good ways of working can be lost;
• When there is a fear that staff will be blamed;
• Staff feeling alone; and
• Lack of training and qualification opportunities, particularly within social care.

3. What evidence is there of good practice in the respective health and care sectors (nationally and internationally) of safety culture?

Three examples were looked at in the review. One area made safety culture a priority. To do this, they made sure that they were leading by example. They undertook training. This made their managers feel empowered.

They changed how they spoke to staff. This reduced worry about being blamed for incidents.

By improving safety culture, they saved around £2.5 million. This saving was made as they were able to reduce suspensions. They also reduced disciplinary activity, whilst employing more staff.

4. Where are the areas of strengths and weaknesses within current research?

Most of the research on safety culture comes from hospitals. Less research has been done beyond that.