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How to make a visible difference to culture

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In part 2 of our two-part series on James Paget’s culture change, a matron gives her perspective.

he culture at James Paget hospital had become punitive before our change in leadership. We would audit then look to criticise.

As matrons, we had to change this. I’ve achieved this by being visible in wards and giving staff positive feedback, even when I am making negative comments.

For example, I may say that a chart they’ve filled in isn’t as expected, but I will say at the same time that intentional rounding was done well.

I’ll say, for example, “I noted that you offered a patient a drink, which is good practice, but didn’t document it.” My mantra is: if you didn’t document it, it didn’t happen. I have to ensure they keep records accurately.

The staff used to feel upset that they had let patients down. I had to convince them that they may have provided good care but evidence of this was omitted from records.

Staff were frightened of making a decision in case they were the one on whom the axe came down. They also worried they would be sacked or disciplined if they documented something inaccurately, such as giving a patient a drink.

We had to encourage staff to improve vigilance and be aware that continuing poor practice was not acceptable.

I am now better organised, following up actions agreed and not doing everything myself - I now advise people where to get help instead. And I try to understand how staff feel.

Being visible on wards was key to encouraging staff to speak out and feel confident in doing so. For example, raising concerns about patient safety resulted in extra staff being provided to support patients at high risk of falls.

To encourage dialogue, I have two meetings a month with my senior sisters and human resources and finance staff, where we discuss staffing, vacancies, personal development planning, cost improvement, falls, complaints, and pressure ulcers.

This engages the senior sisters and makes them accountable for their ward areas. This has enabled them to make decisions, whereas previously they were too disempowered to do so.

Staff now feel engaged and the culture has changed.

Sarah Plume has been a matron at James Paget hospital for three years. She has worked as a nurse for 28 years.

How to engage staff

  • Support staff who are performing well as well as those who are performing poorly
  • Manage and challenge behaviour that is negative or at odds with your values
  • Listen to and address staff concerns
  • Use staff who are engaged to influence and enthuse others. Staff are the people who can engage other staff, so are your biggest resource for culture change
  • Remain patient focused – if staff think change is just bureaucracy they won’t do it, so explain the importance of completing documentation from the patient’s perspective
  • Don’t assume staff can lead change without support – even those performing excellently need encouragement


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Readers' comments (1)

  • What a great article by someone who is inspirational in nursing. At the risk of sounding patronising (not intended), congratulations for adopting such a human and common sense approach.

    We all know how it should be done, but so often we don't do it. There are lots of reasons why it is hard to put the theory in to practice, for example, sometimes we don't have the personal attributes to pull it off and sometimes there are external barriers we are not able to overcome, but when we succeed, it is fantastic and to be celebrated.

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