NHS Resolution’s Being fair report aims to promote a just and learning culture when things go wrong in the NHS. A just and learning culture is the balance of fairness, justice, learning, and taking responsibility for actions. It is not about seeking to blame the individuals involved when care in the NHS goes wrong. It is also not about an absence of responsibility and accountability.
While the Being fair report is predominantly about how staff are treated, this is with the intent to ensure that the benefits of a just and learning culture for staff will have a significant and positive impact on patients and their families.
Since the publication of Being fair in 2019, NHS Resolution has promoted Being fair guidance at conferences, stakeholder engagement events, meetings with members and beneficiaries and through training programmes.
Naomi Assame, NHS Resolution’s Head of Safety and Learning, reflects on what has been happening across the health system, since its publication.
There has been an increased focus on the concept of a just and learning culture, which has been referenced in a range of publications across a number of partners and stakeholders. Examples of where a just and learning culture is promoted and the work of Being fair referenced and built upon include:
- The development of a National Patient Safety syllabus was a recommendation that stemmed from the NHS England/Improvement National Patient Safety Strategy launched in July 2019. The syllabus outlines the principles of safety culture and explains to learners the effect blame culture has on organisational learning. The syllabus also refers to the Just Culture Guide, published by NHS England and Improvement in 2018.
- In June 2021, NHS England/Improvement launched its ‘People Promise’, which shares its commitment to ensuring a culture within the NHS that is compassionate and inclusive, and addresses workforce and workload challenges.
- The Social Partnership Forum (SPF) brings together NHS Employers, NHS trade unions, Health Education England, NHS England and Improvement, and the Department of Health and Social Care to contribute to the development and implementation of policy that impact on the health of the workforce. Throughout 2021, the forum has published guiding principles on implementing a just and learning culture, produced resources on managing employees compassionately and in a just and learning way, and most recently have published a case story on how Cornwall Partnership NHS Foundation Trust has created a just and learning culture.
- Health Services Investigation Branch (HSIB) published a Learning Report on supporting staff involved in patient safety incidents.
- The Parliamentary and Health Service Ombudsman (PHSO) is currently piloting the NHS Complaint Standards, model procedure and guidance. These will be refined and introduced across the NHS in 2023. The draft guidance outlines the importance of promoting a just and learning culture and refers to Being Fair.
- Building from NHS Resolution’s work, the Yorkshire and Humber Improvement Academy (YHIA) have worked with the Yorkshire and Humber Patient Safety Translational Research Centre (PSTRC) to develop a Just Culture Assessment Framework (JCAF) to support organisations in measuring and improving their organisational culture Just Culture Assessment framework for trusts for responding to patient safety incidents.
- In October 2020, Northumbria University launched its four-day course ‘Principles and practices of restorative just culture’ in conjunction with Mersey Care NHS Foundation Trust. This CPD programme offers the opportunity for participants to explore and critically analyse the concepts of Restorative Just Culture approach and consider how these can be applied. There is also a community of practice online.
The future for Being fair
The NHS’s most valuable resource are its people. They are critical to the delivery of safe and effective patient care.
While there have been notable achievements in the health system around culture since Being fair was first published in 2019, we recognise there is more work to do to continue to promote a “just and learning culture” when things go wrong, across the system.
Going forward, it is essential that NHS Resolution continues to collaborate with key stakeholders to resolve the factors contributing to the current major workforce crisis. We are currently reviewing and updating the Being fair report and will be launching Being fair part two in the spring. Being fair part two pays particular attention to:
· The importance of instilling a healthy workplace culture that is psychologically safe, compassionate and meets the basic needs of staff
· Clarifying what constitutes incivility, bullying and harassment
· Guidance on how to manage concerns fairly without premature escalation to professional regulators
· Taking meaningful action in a way that is proportionate, fair and transparent.