Keith Brown: 'Give nurses the skills to create transparent and safe cultures'
We need leadership training that focuses on the care of the patient, says Keith Brown
In the past year, we have seen endless reports slamming nurses in a “culture of neglect”, “culture of cruelty” or the “culture of assumption” for their care of older and vulnerable patients.
Judge Neil Ford QC sent two nurses and nine support workers from Winterbourne View to jail, citing the “culture of cruelty”.
Much of the focus has been on nurses themselves, but there has been very little discussion about what is behind these “cultures” - and, perhaps even worse, all those who knew what was going on but remained silent or were not listened to.
The question that has really concerned me is how could there be so many people working in Winterbourne View who did not raise the alarm? How does a culture like that start in a hospital or residential home and who is looking at the leadership that can allow it to happen?
There has to be a radical change in the way health bodies train those working with vulnerable people so they know how to raise the alarm when they find an abusive culture and how to exercise professional judgement in complex and often difficult situations.
“I want the student nurse, the shift nurse leader and the cleaner all to know what to do, how to raise concerns and to ensure they are listened to”
The only way to stop abuse persisting is by giving everyone - from cleaners to nurses to chief executives - the skills and confidence to raise their concerns if they suspect abuse and, importantly, to overcome resistance to their suspicions. That means they must work through what we call “crunch moments”. You have to give people the opportunity to develop their capability and skills to manage themselves and their stresses so that during crunch moments they are able to make the right decisions. At Bournemouth University, we call this “self leadership”.
Millions of pounds are spent on training in healthcare every year. We are working with 36 NHS employer partners and know that only a tiny fraction of this training is ever assessed to see if it makes a difference and that nurses and colleagues are performing more effectively as a result of it. We are calling for greater impact evaluation to measure the effectiveness of training in the health sector.
It is too easy for us just to put the spotlight on St George’s Hospital in London, Mid Staffordshire Foundation Trust or Winterbourne View. Many abuses occur but are not reported. I want the student nurse, the shift nurse leader and the cleaner all to know what to do, how to raise concerns and to ensure they are listened to.
Just as critically, directors of hospitals and clinical leaders must be given the leadership skills to create transparent cultures. This training needs to be tailored to the specific issues of hospitals and community care. Generic leadership courses are not good enough - we need leadership that focuses on the care of the patient.
While commercial management training has its place, it has often not been focused enough on the healthcare sector. These qualifications are too focused on commercial, private sector principles such as making a profit. Budgets must be managed but financial skills are not enough - you need professionals with self-leadership skills who can exercise professional judgement to develop a culture that prevents abuse of any kind.
Self-leadership skills are needed for everyone, not just senior managers, so that all are able to discharge their responsibility to care for patients. Impact assessments and evaluations are needed to ensure this is all working and making a difference in every health organisation.
It is time to stop making nurses the culprits in these abuse scandals. Instead, nurses must be given the skills to create transparent and safe cultures.
Keith Brown is director of the National Centre for Post Qualifying Social Work at Bournemouth University