This is one of the recommendations from the ‘departmental’ section of the RCOG/RCM undermining toolkit.
Create a positive culture, or a cultural shift
The results of a University Hospital Southampton (UHS) investigation (see ‘Understand your organisation’), which involved all staff groups, revealed that:
- Many midwives experienced difficulty asking questions and speaking up
- Not all midwives felt involved in decision making
- The majority of all health professionals felt feedback and debriefing needed to be improved
To address these issies, UHS introduced a number of strategies and interventions, many of which are included in this section of the toolkit. UHS established a multidisciplinary group known locally as the Positive Safety and Culture Team, whose purpose was to engender change and create a positive culture within which teams were effective and associated with a number of key attributes:
- Appropriate authority gradients exist within which hierarchies do not stifle the free flow of information
- Superiors always listen to concerns and respond appropriately
- Participation is open and supportive, involving all parties
- Individuals assert opinions through questions or by stating an opinion at critical times
- Regular feedback and debriefing occurs to close the loop
To assess the effectiveness of these changes, the original UHS was replicated. The results of this second survey demonstrated that there had been some improvements, corroborated by the improved GMC survey results and other data. Notably, there was an improvement in midwives’ confidence to ask questions when they were unsure, and decision making involving the whole team.
References and further reading
- Allen S. Lessons learned from measuring safety culture: an Australian case study. Midwifery 2010;26:512–9.
- Cresswell K, Sivashanmugarajan V, Wasim L, Wai Y. Bullying workshops for obstetric trainees: a way forwards. The Clinical Teacher 2014;11:1–5.
- Hindle D, Braithwaite J, Iedema R. Patient safety research: a review of the technical literature. Sydney: Centre for Clinical Governance Research, University of New South Wales; 2006.
- Krause TR, Hidely JH, Pinakiewicz DC. Taking the lead in patient safety: how healthcare leaders influence behaviour and create culture. Hoboken, NJ: Wiley; 2009.
- Murphy JD. Flawless execution: using the techniques and systems of America’s fighter pilots to perform at your peak and win the battles of the business world. New York: HarperCollins; 2006.
- Thomas EJ, Sexton J, Helmreich RL. Translating teamwork behaviours from aviation to healthcare: development of behavioural markers for neonatal resuscitation. Qual Saf Health Care: 2004;13:157–64.
- Van Herwijnen I, Burton S, Mountfield J. Positive team culture: improving patient safety on the labour ward. Poster presentation; 2013.
- Wachter RM. Understanding patient safety. New York: McGraw Hill Medical; 2008.