Mersey Care NHS Foundation Trust
This case study examines how Mersey Care NHS Foundation Trust addressed issues around the NHS Workforce Race Equality Standard (WRES). The WRES focusses on nine indicators comparing the experiences of Black and Minority Ethnic (BME) staff with those of White staff: for more detail on this, see the WRES web site. This is one of several case studies on this site relating to the WRES: click here for links to the others.
WRES objective being addressed
WRES Indicator 3: Relative likelihood of BME staff entering the formal disciplinary process compared to white staff
Prior to 2016 the trust had a high number of the workforce going through disciplinary investigations post incidents, with lengthy suspensions and investigations, yet more than half ended up with no case to answer. Putting those employees through unnecessary investigations damaged the psychological safety and trust with staff affected.
What they did
The trust began to pilot a new approach in 2016 as part of its approach to adopting a Just and Learning Culture, based on the renowned safety expert Professor Sidney Dekker. We began looking at the concept of second victim, the care giver. When something goes wrong, the first victim is the patient who is harmed, but the care giver is harmed too. We had never fully considered the impact on staff, we got too caught up in processes, and were focusing too much on who did something wrong, rather than who is hurt and who needed our help. Our approach simply was not compassionate enough.
We engaged with staff, managers and staff side, reviewing our systems, support and practices. The aims were used to alter our approach to employee relations to escape the mindset of finger pointing. We also reviewed the language we use in HR which can be quite legalistic and retributive. We piloted the approach in one division and once we saw the impact we implemented it trust wide.
What was the outcome?
The cultural shift has seen a major reduction in disciplinary investigations over the last two years by 54%, yet in the same time our workforce has more than doubled.
Our evidence has documented an estimated £1.7 million savings from clinical suspensions and back fill alone, with further cost savings identified.
We have seen year on year improvements in the staff survey results, particularly in the safety domain.
We are now developing policies to support not punish, developing approaches in partnership and with clinical facing teams, building trust so give people the confidence to raise issues before they become major problems.
We have written a research study with Professor Dekker and colleagues on the economic viability of restorative just culture. We have also worked in partnership with Northumbria University to develop a four-day accredited programme to share our learning with other organisations to give them the skills and practice expertise to accelerate the impact of our lessons.
Full version of this case study
NHS England web site