Rights at work: not playing the blame game

07 September 2018

The new Just culture guide should help staff to be open, to learn and to feel fairly treated, says Unite’s head of health Sarah Carpenter.

Singling out an individual in patient safety incidents is rarely appropriate. Unite representatives supporting members at disciplinary or capability hearings often raise issues around the failures of systems and processes, as well as the support that members need from their employers.

Now these points are being echoed by NHS Improvement in its Just culture guide, which can be found, along with training scenarios, here. There is also a Facebook Live discussion with NHS Improvement on the Unite in Health Facebook page that talks about the guide in more detail.

It is a priority in the NHS to develop a culture of fairness, openness and learning by making staff feel confident enough to speak up when things go wrong rather than fear blame. Indeed, a culture of blame is more likely to encourage cover-up.

NHS Improvement says: ‘Supporting staff to be open about mistakes allows valuable lessons to be learnt so the same errors can be prevented from being repeated. In any organisations or teams where a blame culture is still prevalent, this guide will be a powerful tool in promoting cultural change.’

The guide is intended to highlight important principles that need to be considered before formal management action is directed at an individual staff member, and takes each separate action – or failure to act – through a series of considerations, one step at a time. If there are multiple actions, these must be considered separately.

'Staff should feel confident enough to speak up when things go wrong, rather than fear blame'


How does it work?

This guide supports a conversation between managers about whether a staff member involved in a patient safety incident requires specific individual support or intervention to work safely.

  • A series of questions helps clarify whether there is something specific about an individual that needs support or management, or whether the issue is wider, in which case singling out the individual is often unfair and counterproductive.
  • The guide helps reduce the role of unconscious bias when making decisions and ensures that all individuals are consistently treated equally and fairly, no matter what their staff group, profession or background. This is similar to the approach taken by some NHS trusts to reduce disproportionate disciplinary action against black and minority ethnic staff.


What should Unite members do?

We know from NHS trusts such as Mersey Care that this approach leads to a far better organisational culture, so we urge members – even in those countries NHS Improvement doesn’t reach – to have a look at the guide. It is an excellent tool for many situations, and can assist managers in their preparations before incidents occur.

Unite reps should familiarise themselves with the guidance and ask at staff-side level how their trust intends to use this tool, and what training will be offered on the staff side and management side to ensure that they use it appropriately. The NHS Improvement website has some training scenarios, but Unite training will also be provided, which can be requested through regional officers.


Picture credit | Sam Kerr