A Focus on Culture in Social Care

We talk a lot about workplace culture – for good or (more often) when shortcomings are exposed. But what exactly is it and how do you create a culture that fosters the routine delivery of excellent care and positive outcomes? That’s what we’ll explore in this blog.

First, the definition. Workplace culture is what makes your organization unique. It is the character and personality of your organization as created by the shared characteristics of your people: their values, beliefs, interactions, behaviours, workplace, norms, and attitudes.

Closed cultures

While positive culture supports excellence, a poor – or closed – culture in a social care setting increases the risk of harm. The Care Quality Commission (CQC) defines a closed culture as one that “can lead to harm, including human rights breaches, such as abuse. In these services, people are more likely to be at risk of deliberate or unintentional harm.”

The hallmarks of a closed culture

Closed cultures are marked by the following traits:

• Limited (or no) focus on ensuring people have access to their family.
• Limited (or no) respect for people’s privacy.
• Care that is task, time, and staff driven, not focused on the individual.
• Decisions made without appropriate reference to the Mental Capacity Act 2005.
• People’s personal distress is not dealt with, nor is any disorientation. People who are living with dementia and who become distressed are referred to using derogatory language.
• Restraints may be used without agreement of the multi-disciplinary team or discussion with the person using the service, their family or advocates.
• Record keeping is inaccurate and not sufficiently detailed.

A longstanding issue

Over many years, we have seen and heard too many reports and investigations into care services where closed cultures appear as the root cause of (at best) inadequate performance and (at worst) serious abuse or neglect. Such closed cultures may develop anywhere, but we know there are certain services and groups of people who are at greater risk. This includes services that care for people with learning disabilities and autism, as well as older people who may not have regular contact with their families.

These issues are not new. In the last 15 years, we have watched undercover documentaries uncovering abuse at Winterbourne View (2010) and again in 2019 at Whorlton Hall, as well as the public inquiry into the Mid Staffordshire Hospital NHS Foundation Trust, whose report was published more than a decade ago in 2013. But poor workplace culture is not inevitable. Quite the opposite.

A caring culture

Fostering a positive culture is critical to the performance, wellbeing, inclusivity, and quality of your teams. But how to you build a positive culture. The 2020 CQC report Right support, right care, right culture: How CQC regulates providers supporting autistic people and people with a learning disability outlines principles that can be applied beyond the focus of the report’s title to every care setting and to everyone who uses adult cost care services.

You must also consider how you can evidence culture to your CQC inspector. When we look at the key questions and quality statements used by the regulator, it states that:

There is an inclusive and positive culture of continuous learning and improvement. This is based on meeting the needs of people who use services and wider communities, and all leaders and staff share this. Leaders proactively support staff and collaborate with partners to deliver care that is safe, integrated, person-centred and sustainable, and to reduce inequalities.

Let’s unpack this for a moment and ask what the quality statement actually means in practice.

• Leaders ensure there is a shared vision and strategy, and that staff in all areas know, understand and support the vision, values, and strategic goals, and how their role helps in achieving them.
• Staff and leaders ensure that the vision, values, and strategy are the result of a structured planning process undertaken in collaboration with people who use the service, staff, and external partners.
• Staff and leaders demonstrate a positive and compassionate listening culture that promotes trust and understanding between them and those using the service, and that focuses on learning and development.
• Staff at all levels have a good understanding of equality, diversity, and human rights, and they prioritise safe, high-quality, compassionate care.
• Equality and diversity are actively promoted, while the causes of any workforce inequality are identified and addressed.
• Staff and leaders ensure any risks to delivering the strategy – including relevant local factors – are understood and have action plans in place to address them. They monitor and review progress against delivery of the strategy and relevant local plans.

Finally… top tips!

1. Be clear about your vision and your values, and communicate these to staff, partners, and people you support.
2. Discuss those values in supervisions, look for them during spot checks, and confirm them with those you support during reviews.
3. Share your vision, improvements, and successes in newsletters.
4. Have staff champions who uphold and champion those values.
5. Make lessons learnt part of everyday handovers, WhatsApp groups, and staff updates.

Questions about workforce culture? Our experienced team is here to help. Contact us today for more information on 01305 767104.

For more information on A Focus on Culture in Social Care talk to W&P Assessment and Training Centre