The Francis Report highlights the need for organisations to create and maintain the right culture to deliver high-quality care that is responsive to patients' needs and preferences.
But what is the 'right' culture of care? And how can organisations assess their culture of care and take steps to improve it?
Drawing on evidence, our experience of working with NHS boards and teams of NHS staff, and our work with staff and patients, we have identified a number of factors that characterise a good culture of care. Below you'll find relevant resources for each factor.
A clear vision for quality
Staff and patients should be able to recognise that providing high-quality − clinically excellent, safe and patient-centred − care is the main purpose of the organisation. This should be reinforced through everything they do.
Organisations' goals for improvement need to be consistent and clear. Staff, non-executive directors (NEDs) and governors should understand and be able to explain what their organisation is doing to improve care.
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Patient-centred leadership: rediscovering our purpose
This report summarises the main findings of the Francis Inquiry into the failings of care at Mid Staffordshire in relation to NHS leadership and culture.
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Preparing for the Francis report: how to assure quality in the NHS
With the Francis Inquiry report due in the autumn, we set out our views on how the system of quality assurance needs to evolve and how it should operate.
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Putting patient safety first: how long will it take before the NHS learns from its mistakes?
Candace Imison draws on some of the inspirational stories we heard at our 2013 Annual Conference to look at how the NHS could improve patient safety by learning from mistakes.
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Creating cultures that put patients first
The culture that patients are treated in is the one that we all work in, and if we are to learn from Francis and truly improve the NHS, it starts with us, says Donna Willis.
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Developing a culture of compassionate care
The Chief Nursing Officer has launched a new vision for nurses, midwives and care-givers. But will it help to develop a culture of compassionate care?
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Jeremy Hunt: making quality of care as important as quality of treatment
In his keynote speech at our 2012 annual conference, Secretary of State for Health Jeremy Hunt called for quality of care to be as important as quality of treatment.
Highly responsive to patients' needs and preferences
Organisations should respond to feedback in any form, dealing with concerns and complaints quickly and at the right level. They should ensure that care is designed around patients’ needs, and that patients and carers are included in decision-making and in discussion about change.
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The patient-centred care project: evaluation report
Our evaluation report of a patient-centred care, evidence-based co-design project run by Guys' and St Thomas' and King's College Hospitals.
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Patients’ preferences matter: stop the silent misdiagnosis
Our paper calls for doctors to aspire to the same standards of excellence in diagnosing patients' preferences for their care as they do to diagnosing disease.
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Transforming patient experience: not a quick fix
Turning around a culture of care cannot be achieved through a quick fix. It takes courage, because you can’t start to improve things without first admitting that you could have been doin...
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Patient-centred care: the universal power of stories
Jocelyn Cornwell discusses the dynamic, culture-changing power of stories and story-telling in health care in her new blog.
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Working with patients to improve health services: Experience-based co-design in practice
Joanna Goodrich asks can we really expect to improve services in a way that makes a difference to patients if we don’t listen to their experiences?
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Improving patient experience: it's the little things that matter
The Point of Care team reflect on how the smallest actions on the part of staff can make a huge difference to patients’ experience of care.
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Marc Bush: Making better use of patients' experiences
Dr Marc Bush, Director of Policy and Intelligence at Healthwatch England, spoke our patient voice conference, exploring the role of Healthwatch England, and the importance of involving p...
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Leslee Thompson and Anndale McTavish: achieving organisational change in partnership with patients
Leslee Thompson and Anndale McTavish share how the team at Kingston General Hospital have worked in partnership with patients and families to achieve massive organisational change.
Supporting staff to deliver the best care
Organisations should provide staff with supervision, support and training that is appropriate to the needs of the patients and service users they will be working with. Staff should have opportunities and time to suggest improvements, and in organisations with the right culture of care they will say they feel valued. Individual champions of good patient care should be celebrated, and team leaders should be supported to make good decisions and build great teams, acting as role models for staff in providing the right care.
The physical and mental challenges of health care jobs must be recognised, and staff should be given the right support and the opportunity to discuss their experiences.
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Leadership and engagement for improvement in the NHS
Leadership and engagement for improvement in the NHS: together we can makes the case for engaging staff, patients and boards, and for building relationships across systems of care.
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Will hourly rounds help nurses to concentrate more on caring?
While Jocelyn Cornwell welcomes a commitment to hourly nursing rounds, will the introduction of new measurements just increase bureaucracy in patient care?
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Can we guarantee compassionate care?
Can we guarantee patients compassionate care? Jocelyn Cornwell argues that while we can't currently guarantee this, we should be doing more to make it likely.
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Care and compassion in the NHS
In light of the Health Service Ombudsman's recent report, Jocelyn Cornwell examines ways to improve NHS care, including intentional nurse rounds.
An open and just environment
Staff should know that they are expected to 'do the right thing' even if that challenges the status quo. They should feel able to talk about, reflect on and challenge current practices without fear of personal repercussion. Organisations should adopt a non-punitive, learning approach to errors, and should instigate reflective mechanisms such as peer review. Staff need to be encouraged to use ‘trial and error’ and to experiment − without creating inappropriate risk for patients − with new ideas and ways of working.
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Enabling compassionate care in acute hospital settings
Part of the King's Fund Point of Care programme, 'Enabling Compassion' was the first in a series of workshops, and was intended to gain insight into what prevents and enables compassiona...
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Leadership and engagement for improvement in the NHS
Leadership and engagement for improvement in the NHS: together we can makes the case for engaging staff, patients and boards, and for building relationships across systems of care.
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Hospital Pathways programme: lessons learned
We describe the Hospital Pathways programme, the method used to evaluate it, what we learned about the approach, and how the lessons have influenced the Patient and Family-centred Care p...
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Why do people find it so hard to speak out in the interests of patients?
Health care staff are usually motivated to enter their professions by a desire to make a difference for patients and service users. Why then, do they find it so hard to speak up for pati...
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Are we expecting too much from the Care Quality Commission?
A Public Accounts Committee report has highlighted the challenges the CQC has faced since it was set up. But are we expecting too much from a quality regulator?
Boards understanding their role in developing the right culture
Boards should set the tone in how they react to incidents and learn from their mistakes; they must be committed to transparency, demonstrate curiosity, and be open to challenge. They should be clear about how they account for quality to service users, the public and regulators. There should be a balance between internal and external focus and between strategy and operations.
A board that promotes the right culture of care can provide feedback and challenge to senior clinicians, and is able to devolve to clinical teams within a strong governance framework.
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Putting quality first in the boardroom
The report starts by examining what is meant by the term 'clinical quality' and why it has the potential to be marginalised in the boardroom. It goes on to consider the dynamics of the b...
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From Ward to Board
This project examined the role executive nurses can play to influence the clinical quality agenda at ward level.
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Elisabeth Buggins: are we expecting too much from the regulator?
Elisabeth Buggins discusses the role of the board with regards to quality and regulation.
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Letter to a friend, a non-executive director on the board of an NHS Foundation Trust
Jocelyn Cornwell gives her advice to non-executive directors following the Francis Inquiry report.
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Board leadership: handle with care
The Keogh Review was hard-hitting about the need for change and supportive for those who will need to drive it. This is a delicate balance, and board leadership must be treated with care...
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Mid Staffordshire: a hospital that lost its way
Stephen Moss, Chair of Mid Staffordshire, spoke at our conference this week about the lessons he had learnt from the 'story of a hospital that lost its way'.
Adopting the right leadership styles and modelling them for emerging leaders
Leaders should be flexible in their style, being directive when necessary, but also engaging others in decision-making. They need to recognise the complex environment of health care and should work between teams and organisations as well as within them. Organisations with the right culture of care recognise the positive relationship between medical engagement and organisational performance, and encourage partnership between clinicians and general managers and engagement with patients.
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Developing effective leadership in the NHS to maximise the quality of patient care
Using feedback from a number of experienced NHS leaders, Chris Roebuck reviews past NHS leadership development and identifies leadership development options from the commercial sector th...
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The roles of leaders in high-performing health care systems
This paper reviews five health care systems that are viewed as 'high-performing', using cross-case methods to identify key factors linked to their success, examining leadership strategie...
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Leadership in context: lessons from new leadership theory and current leadership development practice
Kim Turnbull James outlines some of the latest thinking in leadership theory and leadership development - not specifically from the health case sector - and includes three case studies o...
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Wai-yin Hatton: nurturing our future leaders
Dr Wai-yin Hatton, Chief Executive, NHS Ayrshire and Arraon gave a motivating speech on nurturing our future leaders at the NHS Leadership and Management Summit 2011.
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Transforming patient experience: not a quick fix
Turning around a culture of care cannot be achieved through a quick fix. It takes courage, because you can’t start to improve things without first admitting that you could have been doin...
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Why engagement matters
If the NHS is to address financial challenges, while improving patient care, leaders will need to balance the pace-setting style that predominates among top leaders.
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Is patient engagement important in leadership?
Is the obsession with organisational structure missing the point? Angela Coulter looks at why NHS organisations need to show leadership in engaging patients.
Using data well to drive quality, safety and experience
Organisations must ensure that the right data − focusing on quality not quantity − is looked at regularly and often. Teams need to be supported to interpret data on outcomes, experience, and patient safety. Organisations should invest in analysis and systems to help make data meaningful for different purposes at team, pathway and board levels.
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Technology in the NHS
How can technology be used to improve care for patients? This report gives examples of how technology could be used and suggests ways to overcome the obstacles to its adoption.
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The Keogh Review: a welcome return to 2008
As the NHS now enters its 66th year, how far have we got towards Darzi's vision of clinical and organisational leaders collecting data on quality and using it to continuously improve car...
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Are we wasting money on care that patients don’t want?
Anna Dixon discusses whether asking patients what care they wanted could be a much simpler solution towards making savings.
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Lord Darzi on quality and data in the NHS
Lord Darzi discusses quality and data in the NHS at The King's Fund's recent event on clinicians, quality and data.
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How to measure for improving outcomes: a guide for commissioners
We've produced two slide sets to help CCGs make the best use of measurement to support them to commission for improved outcomes.
Thinking and acting long term
Organisations must avoid quick fixes; problems that are deeply embedded will take time to resolve. They need to respond to problems as they arise but also implement improvement programmes with the time and dedicated resources to succeed.
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Can you change culture from Whitehall?
Can you change culture from Whitehall? Catherine Foot sets out six opportunities for the DH and NHS England to help them prioritise quality of care and safety for patients.
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How must we change care systems to meet the needs of the future patient?
We've had an incredible response to our debate on the changing patient – with views from politicians, health and social care professionals and, most importantly, patients themselves.
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Simon Gillespie: building a fair and sustainable care system
Simon Gillespie, Chair at the Care & Support Alliance, discusses why social care needs to be reformed and gives an overview of the care and support White Paper and the key recommendation...
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Chris Trimble: how might reverse innovation improve health in the future?
Chris Trimble explains how, while medical technology is allowing us to live longer and healthier than ever before, we are reaching a point where we can no longer afford the developments.
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