The much awaited final draft of the Francis report is finally upon us, amidst a flurry of media activity. We already know that it will highlight the need for NHS organisations to create ‘the right culture’ – for delivering high quality care that is responsive to patient needs and preferences. This need has been apparent for some time and it is astonishing that it has taken the negative impacts on patients, resulting from failings at Mid Staffordshire NHS Foundation Trust and elsewhere, to bring this to the ‘top of the agenda’. Although the 290 recommendations of the report are to be welcomed, there is a risk that organisations will still fail to see the wood for the trees and engage in top-down knee jerk reactions. Such responses to pressures of conformance, arguably common amongst leaders within the system, may well have contributed to these problems in the first place – through creating negative climates focused on achieving targets, rather than real compassion.
A fundamental challenge is to identify what might constitute the ‘right culture’ within such organisations, and to take appropriate steps to develop it. This demands different ways of thinking and we have been working with organisations over the years addressing this very issue. Often this has felt like swimming upstream, where localised improvements have been all too often washed away, by the prevailing tide of the ‘wrong culture’ within the wider system. Trauma’s resulting from the radical structural changes of the last few years, coupled with the ongoing needs to cut costs and shed staff, have not helped. People’s feelings tend to become a low priority under such conditions. Negative climates result in negative attitudes and behaviours which, in turn, contribute to poorer levels of performance. Furthermore, increased downward pressure to improve performance leads to increased employee stress and a ‘negative spiral’ can result. This ultimately undermines the quality of care to patients, who find themselves at the bottom of the hierarchy.
The ultimate aim of the report has to be to enhance the status of patients, as drivers of the process, and motivate and empower frontline staff to be responsive to their needs .It is clear to us that the only way to reverse the entropy in the system is by laying the foundations of a ‘positive spiral’ – where staff at all levels are motivated to work together towards a shared vision, in a climate of mutual support. This demands a shift in thinking and, as psychologists, we are well placed to help bring that about. We have found two approaches particularly useful – one reactive, to negative aspects of the climate which may already be in place, the other proactive, in terms of establishing an alternative positive approach to culture change:
Organisational Behaviour Audit (OBA) is an anonymous on-line instrument designed to ‘take the temperature’ of organisations, or departments, by assessing subjective staff perceptions of, and reactions to: behavioural climate, leadership style and team conflict. Output at both individual and group level allows comparisons to be made between subjective experiences and more objective aggregated perceptions of acceptable behaviour. Follow up interventions include one-to-one coaching, leadership development, board or team workshops, mediation and so on.
The Psychologica Model emerged from European funded research into customer and patient perceptions of service quality and the organisational behaviours which impact on them. The model emphasises the psychological characteristics which underpin the competences and skills required to deliver excellent service quality – with the customer at the centre. A range of online tools and experiential development techniques focus on thinking styles, interpersonal behaviours and actions required to enhance individual and team performance – through modeling appropriate values and establishing a positive climate for services. The ‘right culture of care’ is founded on the interpersonal components of emotional intelligence, demonstrated through compassion, empathy, positive communication and responsiveness. The model captures many of the qualities described in Jane Cumming’s 6 C’s.
For further information contact:
Dr Phil Bardzil
[email protected]
0161 351 2290