Better Culture, Safer Care – Guest Blog by Matt Hill


How we are helping to improve safety culture in the SouthWest

Guest blog by Matt Hill

At the South West Patient Safety Collaborative (SW PSC) hosted by the South West Academic Health Science Network (SW AHSN) we do a lot of work around safety culture. We run a programme called Better Culture, Safer Care which encourages teams to pay attention to and engage with their local safety culture, using different tools such as a survey tool called SCORE which we use in the South West and which measures aspects of teamwork, safety, learning environment and how we improve, local leadership, burnout and work/life balance.  We are also working with NHS Improvement on the national culture work stream, for which I am pleased to be the clinical lead.

Whilst the measurement is the focus of the process, the key to shifting the team culture is the conversations amongst team members that it generates throughout the process. The impact of this programme and those conversations has been really positive and we’ve been sharing its ongoing success in a series of blogs hosted on the SW PSC website.

In this blog we’re going to highlight the stages that facilitate the conversations and do a whistle stop tour of how Better Culture, Safer Care is being used across the region in a wide range of healthcare settings.

Conversation 1

The initial step in the process is to consider who is in the team. We often find that people consider the team to consist of the nurses and doctors but forget about the physios, receptionists and porters who work alongside them to achieve the same goal. It also highlights that we struggle to communicate effectively with all members of the team.

Conversation 2

The explanation to the team of the importance of the safety culture and its links to patient outcomes and staff welfare is a crucial step to motivate the team to complete the questionnaire. Allied to this, it is essential that staff understand that the survey is anonymous and that staff feel psychologically secure enough to answer questions honestly. It is also important that staff know that the results will come back to the staff shortly after they have completed the survey and that they will be used to try to improve aspects of the team culture.

Vicky Romback is from the Glenbourne Unit – a mental health unit which is part of Livewell Southwest.

“The team at Glenbourne were happy to commit to completing the survey…particularly when we described how it was aimed at giving them a picture of how their attitudes, feelings and behaviours might impact on how safely the care was delivered in the unit…my lot take those matters very seriously as you’d expect from an impatient mental health unit rated as ‘Outstanding’ by the CQC.”

Full blog here

Annette Rickard is Consultant in Emergency Medicine at Derriford Hospital, Plymouth.

“We first ran the SCORE Safety in July 2015 and asked everyone in the department to fill it in. We pre-warned staff members and managed to get champions across the tiers – communicating why we were doing the survey; encouraging people ad hoc and getting nurse champions to encourage peers to complete it. We also created a few screensavers explaining what safety culture was.  We were actually really pleased with our response rate, as around 60% of people completed the survey.”

Full blog here

Conversation 3

The Results: this is a non-judgemental process and the results should be used for celebrating strengths and identifying opportunities to improve. They are not about benchmarking or assurance.

Debriefing the results to the local leaders: the results are discussed with the local team leaders first to generate hypotheses about why staff may have answered questions in a particular way. The results should not be justified by the local leaders in any way.

Annette Rickard… “Allan Frankel of IHI talked us through the analysis and the results and put perspective on it. He was able to explain about safety culture and how the SCORE survey tool explores what level of safety culture you have reached within your own organisation – not about comparing with other departments or areas. Once we had received the results we wanted to know more about individuals’ responses.”

Conversation 4

The next step is to debrief the staff to gain the insights into why they have answered questions in particular ways. This is best done using an appreciative inquiry technique and is a crucial step in generating the ideas for the improvement work that this will lead onto. It is essential that the debriefing is carried out in a psychologically secure way so that staff are forthcoming with their views and ideas.

Tina Campbell is Associate Director Medicines Optimisation and Controlled Drugs Accountable Officer at Devon Partnership NHS Trust

“I’m often perplexed why – when it looks like all the ingredients for a great team are there – the reality of ‘being’ in the team is sometimes less than ideal and quite stressful….We are a very productive, effective and efficient team but there had always been something around our ‘team dynamics’ that wasn’t quite right.  We struggled to put our finger on it, but SCORE added another dimension to our conversations and assumptions and forced us all to have a different – and – if I’m honest – a more personally challenging conversation. SCORE has given us a valuable way of delving down into a deeper layer of understanding and insight into how we work together.”

Full blog here

Susanne Smith is Susanne Smith is a Lecturer at Plymouth University Peninsula Schools of Medicine & Dentistry, where she is joint programme lead for the Simulation & Patient Safety MSc, she is also a member of Q.

“Whilst it’s often good to take stock and measure aspects of quality performance, I have been repeatedly struck during the course of SCORE debriefings how the most valuable aspect for staff seems to be the opportunity to talk in a psychologically safe place. I’ve seen amazingly honest conversations, real appreciation of the difficulties of other people s roles, offers of support, and heard tales of how staff have battled austerity, chronic staff shortages, unsupportive systems, physical isolation from key teams/staff, problems with unhelpful professional hierarchies/boundaries, and burnout.”

Full blog here

Conversation 5

Whilst there may be benefits from the conversations in the process so far, the next step of bringing all of the ideas together and identifying which aspects team members wish to work on is vital. Staff involvement in improvement work that they believe is important helps to improve staff welfare and adds meaning to work. It also demonstrates that they have permission to make things better and that they have control over their workplace. The on-going discussions about the improvement projects facilitate further discussions about how the team functions.

Annette Rickard….. “One of the key messages that came out of the survey was a really simple thing to fix. It was highlighted that there was an element of poor communication within the department and this was something that we could fix really quickly and easily, simply by improving the way people speak to each other and getting people to think about the way they were speaking to each other…. For some people, key areas of dissatisfaction were the nursing rota, for others printer problems or the interface between wards and work has started on this by our own staff groups who feel passionately about the problem.”


Dr Jillian Denovan is a GP from Pathfields Medical Practice in Plymouth has established team Huddles at the Pathfields Medical Practice, part of a group of four primary care practices.

“Our SCORE results showed us that there was an opportunity to improve teamworking within the practice, so we looked into a variety of options to help support this. We decided on implementing team “Huddles”, which are team-based meetings aimed at providing a forum for highlighting operational and patient safety concerns. Huddles are used widely in the pre-operative hospital setting, and have shown to have a vast improvement in team communication, patient safety and staff satisfaction in primary care. Most importantly, a team with greater cohesiveness produce better clinical outcomes and higher patient satisfaction.”

Full blog on the South West Patient Safety Collaborative website.

Colin Stuckey is CT Lead Radiographer at Plymouth Hospitals NHS Trust and talks about using the SCORE survey in his department.

“We had managed to garner lots of really interesting information from the groups we debriefed and they have made loads of positive suggestions for change for quality improvement. The upshot is that, via the survey, the team have come up with some really great ideas of ways to support me in my role. It was also really useful to show to my manager what the team were feeling– a lot of it was wanting better communication with the senior management teams, which is so easy to achieve with no added cost to the department.”

Full blog here

Summing up

The socialisation within healthcare is a crucial aspect to high quality care and it has become increasingly hard for teams to meet and have conversations about the care that they deliver.

The conversations that happen as a result of using the SCORE culture survey tool allow teams to understand their perceptions, attitudes and behaviours. This allows teams to celebrate the good aspects of their team whilst identifying opportunities to improve, which they can then develop into improvement projects.

It has been a privilege to be involved with so many teams who want to understand their culture and have a desire to get better. The passion that frontline healthcare workers from all disciplines have to deliver high quality care, and the renewed understanding of the crucial role that each of has in looking after other members of the team and shaping the local culture is reassuring at a time of so many other pressures. We need to create the space to care about our team culture.

 Dr Matt Hill