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Engraining the principles of Safety I and II to create a better staff culture

Engraining the principles of Safety I and II to create a better staff culture

April 2024

 

Our neuropsychiatry hospital, St Peter’s in Newport, has put considerable focus recently on integrating the principles of Safety II into its day-to-day working practices, which has had a demonstrable impact in terms of creating a better culture and promoting greater stability within its staff teams.

In the past, the hospital has had incidents where teams have been quick to blame other teams when things have gone wrong, and when process or prescribed care has not been followed correctly. Understandably, this had caused trust to break down and tensions to arise.

In the last couple of years, within St Peter’s, and across the wider Iris Care Group, to which St Peter’s belongs, there has been significant attention placed on developing initiatives to ensure that we are not just recording and addressing the things that go wrong. We are also putting equal emphasis on encouraging best practice; actively recognising all the things that people do right and providing praise, encouragement and positive reinforcement.

Experience shows that 98% of the time things go right, but most organisations focus on the 2% of things that go wrong as a way of learning and preventing future risk. However, there’s a growing body of evidence which suggests that by also focusing on the 98% of things that go right, you better educate people on what best practice should look like, which further promotes and embeds good working behaviours.

The care we provide to our patients at St Peter’s is underpinned by the principles of relational security, but we recognise that our staff need to feel safe too. If staff feel safe in doing their job they’re less likely to be stressed and more likely to work well in a positive way.

A key factor that makes people feel safe is the relationships they have with their managers and colleagues; they need to feel that these relationships are positive and open, that they’re supportive, and that they’re validating.

 

See it, Say it, Send it

 

The work undertaken at St Peter’s, in partnership with Dr Andrew Hider, Clinical Director at Iris Care Group, lead to the development of a new ‘See It, Say It Send It’ programme across the group. This encourages an environment where everyone feels comfortable to tell each other when things are going well, and when things can be improved, to ensure we are providing the best practice care and keeping the people we support safe.

Staff are encouraged to:

See It – Be proactive and constantly keep an eye out to ensure plans are being followed correctly.

Say It – Tell people when things are being done well and explain what was good about their actions. Equally, if something is not being done correctly they shouldn’t be ignored; colleagues need to be told and helped to understand what should have been done differently.

Send It – Share praise, make sure everyone else knows when someone has done a good job. If something has not happened correctly share that too, not as a means of shaming, but in a positive manner to ensure that lessons are learned.

This acknowledges that there must be a top-down approach with everyone equally committed to following this methodology. If managers are open and supportive, we know that staff will mimic the same behaviours and be equally supportive and equally open to the staff below them.

To support and embed the ‘See it, Say It, Send It’, we have launched a new Staff Recognition App that people are really engaging with.. It lets anyone acknowledge their colleagues’ good work. staff from across the multidisciplinary and management teams are then commenting and adding their own praise. The previous recognition scheme focused on going above and beyond the usual work role, Safety II recognises when staff do their job well. The team at St Peter’s have engaged well with this, making many nominations already. On a monthly basis each service’s senior management team review the recognition posts and choose the ones that exemplify Iris Care Group’s core values best to receive personal rewards.

At St Peter’s, to narrow the gap between other disciplines and the unit staff, and encourage greater mentoring between the multidisciplinary teams, Carla introduced a programme where each team is allocated a month to develop and deliver awareness raising and educational activities that they feel will address common care delivery issues. It also offers opportunities to provide coaching in the moment. They create their own posters to advertise the sessions they run, and there has been a lot of interest and uptake.

Everyone is being encouraged to suggest solutions for common problems. This has created greater cohesion within the teams. In changing the way that we took education to the staff, there’s now more confidence within the multidisciplinary team that issues will be more appropriately managed by everyone across the hospital. Safety I and II issues are monitored through local governance meetings to identify trends and themes for learning. Safety I issues can be addressed through supervision and similarly staff are encouraged to raise Safety II feedback in supervision as evidence of good practice.

Further activities have been organised to promote this more open culture, a recent event to recognise diversity within the staff team as part of celebrating overseas workers in February saw a high response rate to a survey about which countries staff hailed from. Patients and team members then joined together to enjoy activities that involved flags, maps, music, fashion and food from the countries that were represented. Three team members wore coordinated clothing so that when they stood together, they created the national flag of Nigeria!

 

Our learnings

 

At St Peter’s we have been seen real benefits from implementing all these new initiatives:

  • Our multidisciplinary team feel that there’s a clear process to be followed to ensure that staff are working within prescribed care plans and that staff feel supported to do that.
  • People are less afraid of making mistakes. They know there will not be ‘blame’ rather that they will be supported to develop the skills and knowledge to ensure mistakes do not happen again.
  • Staff feel less stressed and safer. Our staff turnover has been reduced along with the need to use high levels of agency staff. A stronger, more consistent team has allowed us to provide better continuity of care which in turn has benefited our patients.

None of what the team at St Peter’s has been doing is revolutionary, but what has allowed this programme to be so successful is that it is not a simple one-off campaign. A series of initiatives have been developed that support the same goal. Staff receive ongoing feedback about Safety I and Safety II principles, so it has become something they are familiar with and fully understand. Staff have been willing to actively support the initiatives because they recognise the benefits not only for their patients but for themselves too.

 

Carla Rawlinson is Clinical Lead at St Peter’s Hospital, a specialist neuropsychiatry hospital near Newport, South Wales. Recently, a key part of her role has been to consider how the hospital could fully embrace and embed the principle of Safety II across everything they do.

About the author:

 

Carla Rawlinson is a dual registered Learning Disability and Mental Health Nurse who completed her nurse training in 1996.

Carla moved into the independent sector, working in secure learning disability and mental health services as nurse, clinical lead and as a hospital manager. Carla also worked in social care as an Area Manager.

During the Covid pandemic Carla returned to working directly as a nurse in a care home, developing new skills and knowledge in relation to neurodegenerative conditions, leading to her moving into her current Clinical Lead role at St Peter’s Hospital.

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