The Francis Inquiry: creating the right culture of care

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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.

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.

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.

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.

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.

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.

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.

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.