Our positive experiences using SCORE Safety Culture Survey

Tina Campbell is Associate Director Medicines Optimisation / Controlled Drugs Accountable Officer at Devon Partnership NHS Trust. She has been working with SCORE survey from the SW AHSN and talks about her positive experiences.
“SCORE has given us a valuable way of delving down into a deeper layer of understanding and insight into how we work together.”
“We have used the SCORE safety culture survey to review and inform current and future practice, and started the first survey in February 2016.  Although at first I would admit it was a bit tricky to get our heads around the results and what that meant to us as a team and service, I’ve found the whole process immensely helpful. Not least to understand and improve my own leadership style and capabilities.
Like most Heads of Service, I’d like to think that I’m a reasonably good leader and that, as well as doing our job to the best of our abilities, there is a high level of team work and psychological safety in my team.  So I’m often perplexed why – when it looks like all the ingredients for a great team are there – the reality of ‘being’ in the team is sometimes less than ideal and quite stressful.  This is further confused when – as a service – you have a sound reputation for reliable delivery of timely consistently, high quality and safe care.  Being a dedicated, task-focussed, hardworking team committed to continuous improvement, we have always tried to make time to review and improve our effectiveness and create an open, just and learning culture, in which individuals are supported to develop, grow and thrive.  Over the last few years we’ve tried most ‘team’ building exercises and initiatives, Myers Briggs, plus countless other personality profiling, 360, being part of the South of England Mental Health collaborative, even laughing yoga and although (as our SCORE survey results show) we are a very productive, effective and efficient team there has always been something around our ‘team dynamics’ that wasn’t quite right.  We struggled to put our finger on it, but SCORE added another dimension to our conversations and assumptions and forced us all to have a different – and – if I’m honest – a more personally challenging conversation.
In short, we were being far too British and polite and didn’t feel able (despite positive culture created) to speak up and challenge or talk about the negative impact the behaviour, attitude and approach of some individuals in the team had on ourselves and others. Initially, the areas highlighted for improvement namely workload /burnout (interestingly of colleagues not self), poor communication, teamwork (in particular the sense of belonging to a ‘bigger team’), double standards / variation were all dismissed as areas that were beyond our control and nothing we could do about it. After several discussions in smaller sub teams we came together as a wider team and were able to positively identify aspects that were in our control and that we could and should change.
We were open about and gave each other permission to challenge unacceptable behaviour in a mature professional manner; we gave a renewed commitment to look after ourselves and each other (take breaks, exercise, share workload), given geographical and organisational challenges commitment to proactively communicate with each other more. We ordered new 4G / wifi enabled phones so we could talk / instant message each other not email! We made useful assumptions, clear expectations and requirements from the vast majority of the team for me as leader to, at times, be less collaborative and hold people to account for their behaviour and approach more. This should be underpinned by clear and consistent service standards.
Interestingly, all of our improvement work has hinged on human factors and team work-– remembering the human beings (both patients and staff) behind the issues – which as an already person-centred service was quite a revelation!  Sometimes, we are so service focussed that we forget that we are ‘people’ too – staff health and wellbeing is as important as the care we provide, in fact it is crucial to build resilience and sustainability. Time spent on nurturing yourself and your team is not indulgent or an optional extra – it is vital in order to be able to continue the great work we do.
Since ‘ripping the plaster off’ with the survey it does definitely feel as if things have improved. I certainly have to ‘referee’ less and people do genuinely appear to be working differently and be more supportive of each other.  It may of, course, be about timing and the maturity of our team (now about 5 years old) and it’s early days, I know, but I am hopeful that unlike the other initiatives we’ve tried in the past – SCORE has given us a valuable way of delving down into a deeper layer of understanding and insight into how we work together and adjusted our view enough to protect us from ourselves and to continue to develop, grow and thrive but in a more healthy and sustainable way!”
If you are interested in improving and developing safety culture within your organisation please feel free to contact our Improvement Lead joanna.pendray@swahsn.com, for further information.

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