Theresa Shaw talks us through how the Creating Caring Cultures model was created adn how it can help busy complex care enviornments introduce change
The Foundation of Nursing Studies works with staff across health and social care helping them to develop themselves, their practice and ultimately improve care.
Increasingly, a starting point is helping people to create more caring cultures.
In caring cultures, patients receive care that is effective, safe and person-centred, and staff feel valued and supported.
Over the past five years, awareness of the impact of culture and the need for culture change has increased. This had been influenced most significantly by the publication of several high-profile reports into significant failures in health and social care in the UK (Health Service Ombudsman, 2011; Patterson, 2011; Francis, 2013).
So, what is culture?
Put simply, culture is ‘how things are done around here’ (Drennan, 1992) – the patterns, habits and routines of practice. People make culture, so each one of us makes up the culture and whatever our role, it’s important for everyone to know that our ideas and actions can change things.
Although it is often organisational culture that is spoken about, organisations are made up of many smaller cultures, for example within departments and teams and at ward and unit levels. It is these “workplace” cultures that have the greatest influence on the experience of patients, families and staff (Manley et al, 2011).
Working at FoNS, I have learnt a great deal from many years of work with practitioners and researchers striving to improve practice. Some struggled to achieve their aims and looking back with fresh eyes, the factors that hindered progress were linked to aspects of the culture and context and the ways this influenced the readiness of people and places to change.
In 2012, I commissioned an independent review looking back at FoNS’ work with 82 teams over 10 years.
The published findings (Manley, 2013) provided insight into the factors that are most effective in enabling culture change. It was notable that the teams that drew on practice development principles (Box 1) approaches were more successful in making and sustaining changes and had a greater impact on workplace culture.
Box 1: Principles of Practice Development
- Aims to achieve person-centred and evidence-based care that is manifested through human flourishing and a workplace culture of effectiveness in all healthcare settings and situations
- Directs its attention at the micro-systems level – the level at which most healthcare is experienced and provided, but requires coherent support from interrelated mezzo and macro-systems levels
- Integrates work-based learning with its focus on active learning and formal systems for enabling learning in the workplace to transform care
- Integrates and enables both the development of evidence from practice and the use of evidence in practice
- Integrates creativity with cognition in order to blend mind, heart and soul energies, enabling practitioners to free their thinking and allow opportunities for human flourishing to emerge.
- Is a complex methodology that can be used across health care teams and interfaces to involve all internal and external stakeholders
- Uses key methods that are utilised according to the methodological principles being operationalised and the contextual characteristics of the programme of work
- Is associated with a set of processes including skilled facilitation that can be translated into a specific skill set required as near to the interface of care as possible
- Integrates evaluation approaches that are always inclusive, participative and collaborative
McCormack et al., 2013, pp 5-7
The review, along with contemporary experiences of changing culture, challenged colleagues and me to think about what is possible in busy complex care environments.
The result is the ‘Creating Caring Cultures’ model (Fig 1) for getting started with culture change which significantly draws attention to the importance of people along with the relationship between staff well-being and care quality (Sanders and Shaw, 2015).
The model is based around the form of a rainbow because like rainbows, it is difficult to see/find the beginning or the end of culture change. The rainbow model is created using six colours, each representing a different intention or focus:
- Explore values and beliefs and agree a shared purpose
- Look at what happens in practice and identify gaps between what we say and what we do
- Develop action plans through shared decision making
- Enable team working and staff well-being
- Commit to learning in and from practice
- Celebrate success and continue momentum
The seventh colour (pink) represents the fact that culture change is a continuous process that needs to be facilitated, preferably by clinical leaders who work in ways that are enabling (Shaw et al, 2008)
The model is aimed at people working in frontline leadership roles across health and social care settings (e.g. ward managers, community team leaders, care home managers). It is not intended to be prescriptive or linear, rather it offers a guide and each team will find its own way of using it. For example, it may be more appropriate to start by spending time talking to staff, understanding their experiences, helping to promote engagement and to enhance their wellbeing.
The complex nature of health and social care means there will always be aspects of care that can be improved, even if there are no specific concerns.
As patients’ needs change, services reconfigure or new staff join, it is valuable to be looking continuously at, and reflecting on, practice to ensure the care being delivered is safe, effective and person-centred. There are many ways of assessing what is happening in practice; gaining that understanding of culture. These include, audits, dashboards, the Friends and Family Test, surveys, compliments and complaints and so on.
There are also tools such as the 15 Step Challenge and the new ‘Culture of Care’ Barometer. However, knowing what is happening is not sufficient to change culture.
The Creating Caring Cultures: Getting Started Model and resources offers a way for clinical leaders to begin to work differently with their staff and take the first steps toward change. As all these the resources are free I encourage you to take a look and see where you might make a start.
Theresa Shaw is the chief executive of the Foundation of Nursing Studies (FoNS)
This short, informative and attractive resource introduces the ways in which you can get started with creating a caring culture using the model we have developed.
The booklet enhances the messages of the animation and gives further guidance on how leaders can get started with creating a caring culture.
There are also a range of online, freely available resources that will help with’ getting started with culture change.
Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, Executive Summary. London: HMSO.
Manley, K. (2013) Insights into Developing Caring Cultures: A Review of the Experience of The Foundation of Nursing Studies (FoNS). London: FoNS. http://www.fons.org/resources/documents/CultureReviewExecutiveSummaryMarch2013.pdf
Manley, K., Sanders, K., Cardiff, S., Webster, J. (2011) Effective workplace culture: the attributes, enabling factors and consequences of a new concept. International Practice Development Journal. Vol. 1. No. 2. Article 1. http://www.fons.org/library/journal/volume1-issue2/article1
McCormack, B., Manley, K., Titchen, A. (2013) Introduction. Chp 1 in McCormack, B., Manley, K. and Titchen, A. (Eds.) (2013) Practice Development in Nursing and Healthcare. (2nd edition). Chichester: Wiley Blackwell. pp 1-17.
Parliamentary and Health Service Ombudsman (2011) Care and Compassion? Report of the Health Service Ombudsman on ten investigations into NHS care of older people. London: HMSO.
Patterson, M. (2011) From Metrics to Meaning: Culture Change and Quality of Acute Hospital Care for Older People. Report for the National Institute for Health Research Service Delivery and Organisation programme. London: HMSO.
Sanders, K., Shaw, T. (2015) Creating Caring Cultures: Getting Started. London: FoNS.
Shaw, T., Dewing, J., Young, R. et al. (2008) Enabling practice development: delving into the concept of facilitation from a practitioner perspective. In Manley, K., McCormack, B. and Wilson, V. (Eds) (2008) International Practice Development in Nursing and Healthcare. Oxford: Blackwell Publishing. pp 147-169.