The King's Fund - Cultural and leadership development review of Healthcare Safety Investigations Branch (January 2022)

Summary

The King’s Fund was commissioned by NHS England to undertake a review of the leadership and culture of the Healthcare Safety Investigation Branch (HSIB), including the culture and leadership needed for success as the organisation moves towards a steady state of independence. This report contains the authors' findings, obtained from individual interviews, focus groups and staff survey results, previous reports and other relevant information. It also contains HSIB staff members' responses to the findings, reflections from The King’s Fund review team about what needs to change, and a plan for the future.

Content

Key findings

• HSIB has a very committed and skilled staff team who do great and important work.
• The organisation exists in a very uncertain current and future context, with confusing accountability and the added complexity of being subject to legislation currently going through Parliament.
• Unclear governance and accountability are compounded by confusion about organisational policies and processes not being followed, while HR support has been lacking.
• We heard mixed views about leadership and culture in different teams. Many staff report poor behaviours from the executive team, individually and collectively, and the team’s leadership is regarded by many as poor.
• This manifests itself through a perceived command-and-control approach to leadership, lack of openness to challenge, hierarchical approaches to management and behaviour that is out of step with the organisation’s values.
• Bullying, sexism, racism and other forms of discrimination and unprofessional behaviours appear to be prevalent and tolerated – this goes right to the top of the organisation.
• The national and maternity teams retain different identities and ways of working, with widespread perceptions of unfair treatment and favouritism.
• All of this is very damaging to the health and wellbeing of staff, diminishes the culture and undermines the potential of the organisation.
• There is a breakdown in trust and lack of confidence that these issues will be addressed by the executive team.