Culture: Why It’s Not Just A Small “C” For Health And Social Care Providers

Culture: Why It's Not Just A Small "C" For Health And Social Care Providers

Key Contacts: Jenny Wilde & Juliette Franklin

Earlier this month, the Nursing and Midwifery Council (NMC) was lambasted by an independent report into its culture by former chief prosecutor Nazir Afzal OBE.

The Council accepted the recommendations of the review, which identified issues of safeguarding – six people had died by suicide while or since undergoing fitness to practise investigation between now and April 2023 – and experiences of racism, discrimination and bullying.

Reflecting on the report, the NMC said the following in a statement:

“The independent report is clear about the link between regulatory performance and our culture. One affects the other and this has created a pressurised environment for our people, which has contributed to poor behaviours and concerning case outcomes in some areas. It has seriously undermined our collective efforts to reach quick, fair and safe decisions across all our casework.”

Their message is clear – poor culture has a negative impact on performance. Such is the case across sectors, and health and social care is no exception.

In those settings, failure to properly nurture and support staff can lead not only to poor care delivery, but to a lack of trust between the care provider and its staff. Staff don’t feel confident or comfortable in raising issues of concern to their employer out of fear that they will not be listened to or that there will be adverse consequences for them personally. This results in escalated matters of concern going directly to the regulator or local authority and triggering formal processes that could possibly have been dealt with “in-house”.

There are real issues around staff retention in the health and social care sector and creating a positive culture at work could go a long way to encouraging staff loyalty and increased self-worth – which, in turn, results in happier employees delivering better care.

“The consequences of a more positive team shines through regulatory inspection reports and commissioner’s quality assessments,” says Health & Social Care partner Jenny Wilde.

Workplace culture can be thought of in two halves – those aspects that are governed by compliance with Employment and Equality legislation, explicitly mandating fair employment practices and prohibiting discrimination, and the softer behavioural and communication practices that determine an employee’s experience in even more nuanced ways. In reality, both aspects are intertwined.

So, on top of being legally compliant, how can an employer go about creating a positive culture with compassion at its heart? After all, a supportive and collaborative culture is not just legally necessary but is a must in these times of staffing crises and increased regulatory and public scrutiny of the performance of health and social care providers.

1. Encourage open communication

• Transparent communication: promote open dialogue between management and employees. Regular updates on company goals and changes help everyone feel informed and valued.
• Feedback channels: establish channels for giving and receiving feedback, such as suggestion boxes, surveys, regular check-ins and clear whistleblowing policies.

2. Align culture with company values

• Clear mission and vision: ensure that company values and goals are clearly communicated and integrated into everyday work.
• Consistent messaging: reinforce the company's culture through consistent messaging in meetings, newsletters, and company events.

3. Build trust and respect

• Lead by example: management should model the behaviour and values they want to see in the workplace.
• Respect differences: cultivate an environment where different opinions and ideas are respected and considered.
• Foster inclusivity and diversity: inclusion programmes can support and celebrate diversity, such as cultural awareness workshops or employee resource groups.

• Be mindful of the “grey” areas that might not be directly mandated by legislation. A good rule of thumb is to think about “kindness.”

“There are areas of behaviour that can fall through the cracks of the protected characteristics outlined in the Equality Act, but can nevertheless create toxic behaviours that exclude others,” says Employment partner Juliette Franklin.

“It’s about being aware of the danger of behaviour that can stray beyond acceptable jokes, banter or practices and into a culture that stereotypes and segregates and isolates individuals or groups.”

4. Address conflict constructively

• Conflict resolution: have clear policies and procedures for resolving conflicts that may arise, and address issues promptly and fairly (see our previous newsletter for more details).
• Avoid a culture of fear: the need for open channels, open discussion and swift resolution of conflict or issues are essential to promote safeguarding and employee wellbeing.

“When an individual experiences bullying or harassment and is too afraid to speak up, or when an individual is accused of harassing, bullying or otherwise unacceptable conduct and is subject to a protracted process, both can suffer impact on their wellbeing,” says Juliette.

Processes should be transparent, as swift as possible, and should encourage open discussion and communication at all times.

• Mediation resources: offer access to mediation or conflict resolution services when appropriate.

5. Promote work-life balance

• Flexible working: offer flexible working hours or remote work options to accommodate different lifestyles and needs. Current legislation requires employers to consider flexible working requests, and the new government plans to strengthen this – although exactly how is currently unclear. This could involve limiting the discretion for refusing flexibility and/or increasing tribunal powers to review employer decisions. Labour says it would mean that workers could benefit from flexi-time and term-time options, suggesting a focus on helping parents.

For anyone delivering services on the front line this is unlikely to have a material impact, but for those in management and administrative roles this is likely to lead to an increase in requests to work flexibly.

• Additionally, the Government plans to introduce new laws about shift scheduling to ensure that workers get proper notice of the times they are required to work and offering some level of compensation to the worker if shifts are cancelled at the last minute. These plans are aimed at rebalancing what has become known as “one-sided flexibility” which disproportionately affects workers on zero hours contracts.

Given the nature of the work in the care sector, this is likely to have an impact, especially to those who create rosters or whose shifts are necessarily unpredictable. Watch this space for further updates as they are made.

6. Support personal development

• Skills development: provide resources for employees to learn new skills and advance their careers, for example through workshops, training sessions, or mentorship programmes.
• Career paths: help employees identify potential career paths within the company and support them in reaching their goals.
• Acknowledgment: regularly recognise and celebrate employee achievements, whether through awards, shout-outs, or bonuses.

7. Encourage collaboration and teamwork

• Team-building activities: organise activities that promote teamwork and strengthen relationships among employees.
• Cross-department collaboration: encourage collaboration across departments to break down silos and promote unity.

8. Create a positive physical environment

• Comfortable workspace: ensure the physical workspace is comfortable and conducive to productivity. This includes ergonomic furniture, adequate lighting, and clean facilities.
• Wellness programmes: offer wellness programmes or amenities, such as a gym membership, meditation sessions, or healthy snacks.

For advice on your Employment practices, contact our Employment team. If you are a health or social care service provider and have any concerns over your safeguarding or the culture aspects of your service delivery, contact our Health & Social Care team.