Blog: Improving team culture to deliver safe sustainable services for patients

Carrie Biddle, Therapies Clinical Governance and Quality Lead at Royal Cornwall Hospitals NHS Trust speaks to us about the benefits of using safety culture assessment and the value of debriefing her team on the results.
“We were recommended to consider using the SCORE survey by colleagues in the Imaging Department of our hospital, who were really positive about the outcomes they had from completing it. SCORE is primarily about safety culture, and we were keen to explore staff health and wellbeing within the wider context of learning, leadership, team working and to consider its impact on patient safety.
We have found that by taking into account the wider context, we have collected rich data which provides real opportunities to improve our culture across different domains to support our staff and enable us to work to deliver safe sustainable services.
We completed the survey in January 2017, received the results in March, I went on a debriefing course in June, and we started debriefing in August of this year. This meant there was a longer gap than you would want to get the results shared, however I found the debriefing course in Exeter incredibly helpful and the debriefing element has been a key factor in the success of the survey.
Some staff impressions of previous staff surveys e.g. the NHS Staff survey (that we complete annually) is that you do the survey and the results are shared and considered in the first instance by senior managers who have then made decisions and taken action based on the results. The actions are then communicated with staff. Colleagues have shared that they haven’t always felt engaged in generating the actions and haven’t readily seen change that relates to them. With SCORE, the debriefing culture puts the results back into the hands of the staff first to consider and agree actions that were then taken back to managers, i.e. what do YOU think needs to change? The debriefing sessions were a real hit with the staff.
We used Appreciative Inquiry in the sessions which kept a positive forward focus on where we want to go for a better future. It was great to get people together and have these discussions, with people being open (not negative) and appreciative. We got loads of ideas. People really found the debriefing sessions useful and felt a sense of relief to be sharing information, which was almost a cathartic process: just by sharing, people felt better.
The teams and managers had the full results in September. Together we are now looking at our next steps as some actions do require full management support for change. Managers are agreeing three key priorities to be taken forward, and teams are being asked to identity a local team priority action – one thing they can start or stop doing. Culture change requires leadership and positive action at all levels.
With regards to delivering the debrief sessions themselves, the SW AHSN were really supportive and put me in contact with someone who had gone through the SCORE survey in Taunton to discuss their experience and practical tips as a facilitator. Using the network to support other people is a great resource to have access to.
Within our therapy department, we are in the process of merging to form an integrated therapies service, encompassing Acute and some Community Trust Therapy Services. The work we have done with SCORE now will act as a baseline of how acute staff were feeling prior to the restructure and can directly feed into changes in practice and culture as we form a new service together. Our intention is to make the changes and to do another survey in about a year’s time.
Carrying out the SCORE survey has been really beneficial; staff engaged and have shown real care for their results. The debriefing sessions connected the staff to the results making it directly meaningful to them. The survey has given us a structured way to look at our culture at work, identify aspects that are important to our staff and impact on the quality of care we provide, and generated workable ideas to improve staff health and well-being.”
If you would like more information or are interested in taking part in the ‘Better Culture, Safer Care’ programme, please contact joanna.pendray@swahsn.com