Speak Up for Safety: A new workshop for healthcare staff about the importance of Just Culture

Summary

The culture of a healthcare organisation can determine how safe its staff members feel to raise concerns about patient safety. Bella Knaapen, Surgical Support Governance & Risk Management Facilitator and Sarah Leeks, Senior Health & Wellbeing Practitioner at Norfolk and Norwich University Hospitals NHS Foundation Trust, have developed ‘Speak Up For Safety’, a Just Culture training workshop that aims to help staff, at all levels, understand the importance of creating an environment that encourages people to share concerns and feedback. In this blog, Bella describes why they thought a training course was needed, outlines the approach she and Sarah took to develop the workshop and introduces the topics covered.

Content

I am an Operating Department Practitioner by background, but in recent years I have moved from operating theatres into clinical governance. This is where I learnt more about the term ‘Just Culture’, which refers to a culture of fairness, openness and learning that helps staff feel confident to speak up when things go wrong. It is about supporting staff and treating them fairly, rather than blaming them. Just Culture allows staff to be open about mistakes and allows us to learn valuable lessons that help prevent the same errors from being repeated.

Culture, blame and accountability can seem like huge topics to explore, so it’s important to make them accessible. Enhancing Just Culture is key to improving patient safety, because if we are all fearful of blame when things go wrong, we aren’t focusing on removing the system errors that result in incidents. Improving Just Culture allows teams and individuals to take ownership of their learning and practice. Rather than waiting for things to go wrong it gives people the confidence and psychological safety to say, “Can you help me get better?” which in turn will improve the quality of patient care. 

Why we developed a Just Culture training workshop

We all understand the deep impact that the Covid-19 pandemic had on individuals, teams and the NHS, through ever-increasing pressures and reduced resources. In my role at that time as local governance lead, myself and Sarah—who was a Trust Professional Advocate at the time—started to notice a thematic issue relating to staff speaking up. Individuals and teams sometimes didn’t feel confident or safe to speak up at the time of a patient safety incident, or they were being reassured by someone more senior that their concern was nothing to worry about. This is not to say that staff were not heard, but that their concerns and feedback were not always being acted upon to improve safety.

As a result, we were seeing a slight increase in certain types of patient safety incidents and we wanted to address this concerning trend. Sarah and I decided to develop “Speak Up for Safety” (SUFS), a face-to-face workshop designed to raise awareness of existing topics covered in the NHS governance agenda relating to Just Culture. The workshop looks at how to understand and apply aspects of the NHS Patient Safety Syllabus and the new Patient Safety Incident Response Framework. It also covers Human Factors, emotional intelligence and introduces specific communication tools staff can use to highlight their concerns. 

Empowering staff to share their concerns about patient safety

The main aim of the project is to ensure that all staff feel safe and empowered to speak up if they are involved in a patient safety incident. We want to continue to develop psychological safety and Just Culture within our Trust by changing staff mindsets around safety culture. We believe SUFS will equip teams to better identify and prevent harm before it occurs and as a result, better advocate for their patients. 

The best bit is that any staff member, regardless of role, profession, grade, team or department is welcome at a SUFS workshop. The workshop has been designed to help individuals think about the topics described and apply these principles to their own area of work. SUFS is aimed at everyone as we need all staff to feel safe and empowered to speak up when raising safety concerns. 

Developing the Speak Up for Safety workshop

Using the Model for Improvement, Sarah and I developed several different ideas before finalising the finished SUFS workshop. The process included running an anonymous pre-workshop survey to understand local teams’ current perception of safety culture, producing summary reports to feed back survey data and a workshop and evaluation. Following several Plan-Do-Study-Act (PDSA) cycles, we were able to make changes to the workshop to develop something that really works for local teams. 

Psychological safety is paramount for both Sarah and me, and when we run the workshop, we set key ground rules at the start. As we are teaching Just Culture we need to practice what we preach. We try to approach the sometimes challenging discussion topics in the workshop with the utmost sensitivity and empathy. We want to help people understand that when things go wrong, it’s often due to a failure of process, not people! It important to recognise that most people don’t come to work wanting to intentionally be involved in a safety incident and we need to change the perception of blame and accountability. 

Since we launched the project in September 2022, we have run Speak Up for Safety for multiple teams within three out of four Trust Divisions. There has been tremendous positive feedback from the teams that have completed the workshop, and we continue to receive new requests from other teams.

Having trialled and tested this project for two years, we are confident that we can now share it with other organisations who are looking to improve staff understanding of Just Culture. You can view the presentation we use to deliver Speak Up for Safety at your trust on the hub. 

About the Author

I am an Operating Department Practitioner by background but currently work within the Surgical Divisional Governance team. Within my current role I'm responsible for maintaining high standards of quality care through responding and learning from incidents, supporting quality improvement work and identifying and reducing risk. I have a personal passion for "Just Culture" and how this impacts patient safety.