Sister leadership is vital in ensuring an appropriate team culture, says Jean White
I recently attended a thought-provoking lecture on the lessons to be learnt from the care failures at Mid Staffordshire Foundation Trust in 2005-09, which are undergoing further examination by the second Francis Inquiry.
One issue that stood out was the importance of the culture that pervaded the organisation at the time and how it was a major cause of system-wide failures.
Simply put, an organisation’s culture should guide how employees behave and, most importantly, prioritise matters that are valued most.
In health organisations, this should include putting patients’ needs first and prioritising the delivery of safe, cost effective and compassionate care. Leaders from board to ward and at team level should understand and reinforce the organisation’s cultural beliefs and values so everyone has a common purpose - the delivery of excellent patient care.
‘Leaders cannot be seen to cut corners or turn a blind eye to poor practice, as this sets the pattern of behaviour for the whole team’
What does this mean at ward or team level? I offer the following reflections.
Sister/charge nurse leadership is essential in ensuring team culture is appropriate. This includes role modelling behaviour they expect to see, setting standards for team performance and addressing any lapses swiftly. Leaders cannot be seen to cut corners or turn a blind eye to poor practice, as this sets the pattern of behaviour for the whole team. These clinical leaders should aspire to motivate and inspire their teams to deliver consistently great care.
All staff should have an annual appraisal, however hard this is to achieve in busy clinical areas. This is important as appraisals offer opportunities for constructive discussions on performance to identify further development to enable the individual to continue to grow.
It is particularly difficult for team members to speak out when they see colleagues failing to undertake their role appropriately. It becomes easier to speak up if the culture in that team promotes open dialogue - telling colleagues when they’ve done well and challenging poor performance. This is something that should be discussed within the team and ground rules agreed on - I don’t deny that this takes a degree of maturity and confidence in team members that may not necessarily be there.
Problems certainly increase when a culture of fear pervades and stops people speaking up. Recognition of a job well done by your peers can be a strong motivator and should not be dismissed.
Complacency is a serious problem in any team that aspires to give great care and must be guarded against. Another reflection from Mid Staffordshire is that a stable workforce with little turnover is not always a good thing. This resonated strongly with me - teams that have been together a long time often develop set patterns of working and relating to one another that breed complacency and stifle the ability to challenge. Even when an organisation’s turnover is low, there should be internal movement of staff to bring fresh perspectives to care environments.
Students deserve excellent mentors and clinical experience to build confidence and ensure competence on qualifying. The culture of health organisations must be positive so the right values and beliefs are instilled. Mentors therefore need to be supported and recognised for the important work they do.
In Wales, work is under way to explore professionalism in nursing and what influences the behaviour of nurses. Part of this programme is a formal evaluation of the national ward sister/charge nurse leadership development programme. I look forward to the insights this work will give when it reports this autumn.
Jean White is chief nursing officer for Wales