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Evaluation backs use of nurse-designed 'barometer' of NHS culture


A tool developed by leading nurses to identify whether a workplace is suffering from a poor culture could be extended and rolled out across the NHS, according to a report on its early use.

The “cultural barometer” was developed by a group of six leading nursing figures that came together in 2011 to call for major improvements in the profession in response to a growing number of cases of poor care, as previously reported by Nursing Times.

They identified a common thread in the reports – that the culture meant staff could not or would not speak up when things were wrong.

The tool, which is based around a series of questions designed to prompt staff to talk about the culture of care in their organisations, has subsequently been piloted at three trusts.

“The barometer is designed to kick start conversations about culture within organisations”

Anne Marie Rafferty

The Culture of Care Barometer (see PDF top-right), an evaluation report on the tool, was published last week at a nursing conference organised by the NHS England London region.

It said the barometer had received a “positive reception” at the pilot sites and that other trusts were “enthusiastic” to embrace it as soon as possible.

“From our discussions with trusts, there seems a strong appetite for using the barometer,” said the report.

It concluded that the barometer added value to existing tools such as the NHS staff survey and Friends and Family Test.

The next steps will involve developing a smartphone “app” and piloting its use in a range of groups and settings, said the report.

The barometer aims to add value to existing metrics, acting as an early prompt to measure the “care culture” in organisations across the country

It is also intended to act as a catalyst for conversations so that problems can be nipped in the bud, help managers ensure that staff are feeling valued, satisfied and able to raise concerns if necessary, and help staff get a better a grasp of the reality of patients’ experiences.

Professor Anne Marie Rafferty, the lead author of the report from King’s College London, said: “The Culture of Care Barometer is designed to kick start conversations about culture within organisations.”

Caroline Alexander, chief nurse for London, added: “The aim of these conversations is to ensure that staff can provide good care to patients, that patients have a good experience of their care and staff feel valued, satisfied and able to raise concerns when necessary.”

  • Nursing Times’ launched the Speak Out Safely campaign in 2013, which encourages organisations to support their staff in raising concerns about care or safety.

Readers' comments (8)

  • why is it always nurses that are being bullied

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  • I genuinely believe this is making a start in the right direction. After all the problems in healthcare though, why leave it until now. There has been discord for decades within the healthcare setting and people have suffered with pressures and stress. Finally, a tool that can be used to highlight departmental issues. This is only the beginning and what strategies will be used to address problems. It will be like climbing a very high mountain with further ones a field.

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  • Nurses are easy targets that is why they are being bullied. They have always followed the crowd, trying to achieve the impossible, afraid of being reprimanded if something is not achieved. They need to stand out as individuals and understand their limitations more. Get used to saying 'no', rather than yes I will do that and that and the other. Recognise that to loose ones pin number a serious issue would have to happen.

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  • 'A tool developed by leading nurses to identify whether a workplace is suffering from a poor culture...'

    what does the photo of the stethoscope in the picture have to do with it? is that the tool? .-)

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  • paradoxical that the RCN were sent to lecture at a European nurses' congress on good team working relationships and ward climates when most healthcare facilities do not have all of the problems experienced in Britain and the NHS. mainland Europeans tend to treat one another with far more respect and value each other as fellow human beings and work in excellent collegial work settings! maybe it just the money and some accolade they were running after!

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  • If nurses are bullying nurses - intentionally or as a by-product of their propping-up a system because they are themselves low on the pecking order - how then does this work in practice. For student nurses, it is the nurses and HCAs who are the problem, and there are many areas that are run inappropriately, but the person in charge of that is the one keeping the problem going. To say mentors or Uni-links are the place to go ignores the fact that you have to face the backlash afterwards. There are subtle ways of making a person feel uncomfortable which makes it less likely that you will stick around in training or after registration. The inappropriate have a way of protecting their hold on the situation.

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  • as a senior clinician I found nothing more heart breaking than senior staff bullying their juniors and as suggested above it is often so subtle it is often not detected until serious damage has already been done. those who behave in this way are no better than or superior to anybody else and in fact a lot worse as there behaviour is pathological and abnormal. I am not sure how many of us at some time in our lives and careers have not been subjected to this appalling behaviour.

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  • I have had a certain someone attempt to bully me. Fortunately, I had the confidence to stand up to them. However, as they were the more senior and had their entourage of mainly junior staff and the matron backing them, it still made life rather uncomfortable. I saw it happen to many of their other staff, and supported them as much as I could. I think I was on the hit list, but they'd have had a job on, I was no pushover, and was well respected elsewhere. Senior management must have been either stupid or turned a blind eye, the latter I suspect be true. A tool is only as good as the person using it, so there may still be the opportunity for bullying to go undetected. However, it is an attempt to do something about it.

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