healthcare. a just culture... where are we now?
TRANSCRIPT
A Just Culture…where are we now?
Doing The Right Thing
Patient safety through a just culture in Healthcare
Tracy Boylin Maria Paviour
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What will change culture?
Attitude
Values
Targets
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Targets = Threat = Poor Performance
© Maria Paviour Company 2015mariapaviour.com
© Maria Paviour Company Ltd 2015mariapaviour.com
Targets = Threat = Poor Performance
© Maria Paviour Company 2015mariapaviour.com
© Maria Paviour Company Ltd 2015mariapaviour.com
Targets = Threat = Poor Performance
© Maria Paviour Company 2015mariapaviour.com
© Maria Paviour Company Ltd 2015mariapaviour.com
Targets = Threat = Poor Performance
© Maria Paviour Company 2015mariapaviour.com
© Maria Paviour Company Ltd 2015mariapaviour.com
You can’t change culture
CULTURE = result of actions taken
ACTIONS = emotional environment (how we treat
people)© Maria Paviour Company 2015mariapaviour.com
© Maria Paviour Company Ltd 2015mariapaviour.com
The effects of threat
1. Tyranny – rewards bullying2. Self preservation at any cost3. “Bendable” values4. Arrogance – as a survival mechanism
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© Maria Paviour Company Ltd 2015mariapaviour.com
Answers? Break the Psychopathic Cycle
The PSYCHOPATHI
CCycle
TARGETSTHREAT CULTURE, LOW
MORALE, LOSS OF EMPOWERMENT
REACTIVITY
ERROR INTOLERANCEILLUSION OF PERFECTION
PSYCHOPATHIC FICTIONS
NARROW FIELD OF VIEW – LOSS OF PATIENTCENTRICITY
EMPATHYLITE
DISCHARGE OF RESPONSIBILITY& BLAME GRANDIOSITY
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The AspirationBreak the vicious cycle of the
disenfranchised
PATIENTCENTRIC – DRIVEN FROM “BOTTOM”
UPACCOUNTABILITY Cycle of
courage
LEARNING CULTURESHARED PURPOSE
CO-CREATION, COLLABORATION
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© Maria Paviour Company Ltd 2015mariapaviour.com
Cohesion & shared
values
Recognition of what works
Mutual support
Innovation,
creativity and
change
The Manifestation
PATIENTCENTRIC – DRIVEN FROM “BOTTOM”
UPACCOUNTABILITY Cycle of
courage
LEARNING CULTURESHARED PURPOSE
CO-CREATION, COLLABORATION
Break the vicious cycle of the disenfranchised
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© Maria Paviour Company Ltd 2015mariapaviour.com
What are the answers?
Build Emotional Engagement
Substantially reduce the 3A’s
Increase the Value for Money and Patient Satisfaction
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Transactional/Emotional Engagement and Wellbeing
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© Maria Paviour Company Ltd 2015mariapaviour.com
Financial Reasons - Absence EXAMPLEIndustry statistics
Day sickness absence per annum per
person
average salary
per annum
No. of employee
svalue of days lost
to sickness paSavings on lost days
UK Average sick days 9.5 £30k 7500
£8.4mCost of agency
staff:
£18.1m
UK Engaged Company Aspirational
2.5 £30k 7500 £2.2m
Savings on lost
days £6.2m
plus Cost Agency Staff
£15.9m
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EXAMPLEIndustry statistics
Attrition Rate
average salary
per annum
No. of employee
s
Cost of attrition/
Replacement @ 150%
Savings on lost days
UK Average sick days 14.6% £30k 7500
£49.2m
UK Engaged Company (Aspirational) 5% £30k 7500 £16.2m
Savings £33m
Financial Reasons - Attrition
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Where do we start?
PRIORITY 1
Diagnose your Well being and Emotional Engagement levels
1 SD point improvement in engagement would save NHS £24m from absence alone in acute trusts.
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PRIORITY 2
Well being FIRSTPull people out the riverGo upstream – stop people
falling in
Where do we start?
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PRIORITY 3
Invert the pyramid - Increase Autonomy Patient satisfaction is the driver Clinicians care requirements supported
by creative managers “Only do what only you can do”
Where do we start?
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© Maria Paviour Company Ltd 2015mariapaviour.com
PRIORITY 3Focus on development for 1st Line Nurse Managers Autonomous management of patient
care at the point of need
Creativity Innovation Change
Where do we start?
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Co-creating a Just Culture Actions NOT Words
What we model NOT what we demand Only one target Change … starts from the top…
...the very top
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© Maria Paviour Company Ltd 2015mariapaviour.com
What is the NHS culture?Target/threat driven (led and
managed)Hierarchical in conflict with
Existential (values mismatch)
The Emotional Engagement SpecialistsMaking Sense of Psychological Well-Being for Peak Performance
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