Creating and maintaining a restorative ‘Just and Learning’ culture

As we shape the new Workforce, Training and Education Function, I believe we have a real opportunity to continue to strengthen our leadership, management development, and talent management and transform it into a business-critical activity. Identifying what best practice looks like from within the NHS and beyond will be vital in supporting this work.

I recently had the pleasure of visiting Mersey Care NHS Foundation Trust, one of our People Promise exemplar sites, to learn more about the journey they have been on to create and maintain a restorative ‘Just and Learning’ culture. The culture, spearheaded by Amanda Oates, Executive Director of Workforce, endorsed by CEO Joe Rafferty, and practiced by all of their executive team, is centred around creating a culture where colleagues feel supported and empowered to learn when things do not go as expected, rather than allocating blame. The aim is to prevent creating an atmosphere of reluctance amongst staff in reporting mistakes, and instead focus on creating equitable relationships between staff and leadership that guarantee better patient outcomes remain at the heart of everything they do.

What really stood out was the importance the trust’s leadership team place on championing this practice. In the Review of the Fit and Proper Persons Test, Tom Kark QC outlines that the behaviour of the workforce is influenced by the behaviour of the Board of Directors. Even during the short time I was there it was clear that all levels of the organisations endorsed and hugely valued the restorative approach to culture as a method of addressing problems openly and honestly.

Throughout, I noticed a clear focus of recruitment based on values, the potential of an individual, and how they could grow their own talent. I chatted to many colleagues who through internal development opportunities had been able to progress to managerial positions. I met with colleagues working in Ashworth Hospital who provide care to patients in a very specialised high secure environment facing unique pressures. Their passion and dedication to the patients shone through, many reminiscing over long and rich careers. However, what shone through the most was the strength of their teamwork and how much they shared the same values.

I was also able to visit both Hartley Hospital and Rowan View Hospital, both of which were purpose-built facilities which the architect had specially designed to centre the needs of patients. It was great to hear from Rich, a ward manager, about the positive impact this has had on both patient outcomes and colleague’s experience. Rich also showed me his team’s ‘canvas’, which is one of the ways Mersey Care has been able to realise its strong values. Each team, including senior leadership, created their own team canvas that contains their purpose, objectives, and values. Each canvas does not sit in isolation, but instead forms a constellation of values and unifying purpose shared across the organisation. Almost everyone I spoke to at the trust mentioned their canvas, the genuine enthusiasm and pride in the work was evident.

Mersey Care have seen brilliant outcomes, including a consistently low leavers rate for first year nurses. This is especially impressive during times of large organisational change. But to me, key to their success is that fact they have remained curious, honest, and open-to change. As we begin to act upon the recommendations outlined in the Messenger Review, implement the work of Kark, and align to the new NHS England Operating Framework, I encourage all senior leaders to remain curious and take up any engagement opportunities that may arise. I believe organisations such as Mersey Care, and the values their leaders demonstrate, provide us with important answers we can use to shape a better future, for both staff and patients.

Photograph of Professor Em Wilkinson-Brice

Professor Em Wilkinson-Brice qualified as a nurse in 1992 in Exeter.

She then worked in Oxford, specialising in cardiology and high dependency care, and a firm interest in facilities management later resulted in Em taking the post of Director of Nursing and Facilities at Derby Hospitals NHS Foundation Trust, before coming back to Exeter in July 2010.

During her time at the RD&E, Em has undertaken numerous roles alongside the Chief Nurse role, including leading the Trust’s five year Transformation Programme to deliver a new model of care in partnership with local agencies.

In recognition of the close working partnership between the Trust and Plymouth University, Em was appointed Associate Professor Faculty of Health and Human Sciences. She was in the first cohort of the national NHS Leadership Academy Aspiring Chief Executive programme, completing it in February 2017.