Innovation in a Just Culture

Amanda Oates | Executive Director of Workforce

Innovation in a Just & Learning Culture

Amanda Oates, Executive Director of Workforce Wednesday 13 December 2017

A Just Culture

A just culture accepts nobody’s account as “true”

or “right” and others wrong … Instead it accepts

the value of multiple perspectives, and uses them

to encourage both accountability and learning.

Sidney Dekker

What is Innovation?

“The process of translating an idea or invention

into a good or service that creates value”

“There is no innovation and creativity without

failure.” Brene Brown (Research Professor)

Just & Learning Culture and Innovation

• Systems and processes that we use around patient safety, harm reduction and the

associated need for candour, transparency and openness

• These set up so many opportunities for us to fail (not to go as expected)…..and for

us to LEARN!

• Understanding human error is about understanding the inside perspective not the

outside or hindsight one

• Terms line “investigation” can feel threatening and get in the way of trust or the

ability to make improvements

• Staff surveys – staff speaking out?

Barriers to Transparency

• Fear of consequences, blame, shame and being dismissed

• Lack of support or trust, ‘adversarial’

• Incident investigations

• Lack of feedback . . .

Compassion

6

Just Culture

Do we need it ?What impact will it have for Mersey Care?

Impact of Culture on Workforce

• High performance

• Compliance

• Quality

• Trust

• Attrition

• Sickness

• Employee openness, raising concerns

Delivery of Perfect Care in

Mersey Care

• Delivering our ambition for Perfect Care depends on the development of a

non-punitive culture

• We have found that learning can only flourish when responses to mistakes

are compassionate

• Personal responsibility and professional accountability drives the

organisational learning

• It’s not about 'blame-free' or being tolerant of absolutely anything

• It’s a careful balance of accountability and learning

• A prospective outlook rather than a retrospective bias

• Staff should expect a compassionate response if things don’t go as

expected

Benefits of a Just & Learning

Culture …

For Staff • Acceptance we are not always on our

‘A’ game

• Even the best employees will have blips

• Safe to raise a concern

• Culture that allows the boss to hear bad news

• Empowered to catch errors

• Accountable but not punished for human errors

• Learn when things go well and when they cause harm

• Asking 'what' and 'why' instead of 'who' will drive learning and improvement

For Patients

• All staff protect our values by the choices they make every day in doing their job

• Accountable staff

• Reduce risky behaviour – catch errors before they occur to minimize or prevent errors of the future

• Reckless behaviour is not accepted by anyone

• Staff morale is high as staff are empowered to do the best job they can do

Errors and Answers

Exposing Errors

Reporting Risk

Identifying

Weakness in

Process

Just Culture

supports us

to Learn and

Create

Positive

Outcomes

and prompts

innovation

Innovation

How does Just Culture & Learning

act as a vehicle to drive Innovation?

High Performing

Systems

Effective

Leadership

Autonomy and

Accountability

Best practice

Creates

Opportunity

Quality Account Objectives Year 1

What are we doing? Our Mission,

our Research, our Measure!

• Feedback, and learning will be disseminated within a seven day window

• Mutually influence and shape how we apply new practice

Objective 1:

72 hour review

• Maximise on how we reflect and learn form the practice of colleagues.

• To reflect and learn from the practice of colleagues

Objective 2:

Good practice Stories

• To celebrate success and ‘temperature check’ that our performance reporting correlates with the change in culture

• To provide Intel and support for teams that might require additional support

Objective 3:

Publish quarterly data

Innovation

Just and Learning microsite

• Developed a Supporting Colleagues Policy in conjunction with ward

managers, staff who have been involved in incidents, Staff Side, HR, and

our wellbeing at work services

• Agreed and developed an incident management and resolution process

• Reviewed Management of Attendance policy – going forward this will

become Supporting Attendance Policy

• Established a Just & Learning Culture Task and Finish Group

• Recruited our ambassadors across the organisation

• Focused on the language

• Focused on HR policies and practice

So far we have……..

26

29 29

22 22 22

18 18

13

11

9

7

43

1 1 12 2 2

0

5

10

15

20

25

30

Disciplinary Cases: Jan 16 - Aug 17

Live Cases New Cases Linear (Live Cases)

Workforce Update

Secure Division

Key indicators

DATIX REPORTS

PATIENT MORTALITY

STAFF SURVEY

SPEAK OUT SAFELY

ER CASES

SICKNESS ABSENCE

DATA

OH /STAFF SUPPORT

DATA

RETENTION

OUR

INDICATORS

Next Steps

• Sign off the questions that will inform us whether or not we

are getting it right

• Continue to recruit new ambassadors across the

organisational footprint

• Sidney Dekker back to the Trust January

• Give staff the opportunity to ‘Bid for Sid’

• Learning with Stakeholder event in January 2018

Questions