This research looks at the characteristics of good safety cultures.
We commissioned RSM UK Consulting LLP to carry out this research and write the summary and full report.
Purpose of this research
This research describes good safety culture. It also sets out the parts that make safety culture, and how they might differ in different settings. By reviewing the research that has already been done, this report can identify gaps in what is currently known. This can help identify areas for research in the future.
Background and introduction
Safety is important to how CQC regulate services. During inspections, CQC want to know how safe the care is that is being delivered.
For many years, culture is known to be key for safe care. Culture means the way that people work, the way that they think and the way that they act. Research has mostly focused on what safety culture means for those working in hospitals. There has been less research to understand safety culture in the community (including GPs) and adult social care (including care homes). It is important to understand more about safety culture in these three settings.
The topic of safety culture is complex. There are different ways to define it. Safety culture can look different in different places. Therefore, it has been the subject of lots of research. This report aims to summarise previous research. This can then help CQC to think about how to regulate in a way that reflects the simple basics of safety culture.
Findings from the literature
1. What are the key characteristics of good safety culture, how do these develop and how can these be defined?
There is no one definition of what good safety culture is. This is because it is complex and can change quickly. We have chosen to discuss five features for this report. These summarise key features of good safety culture and include:
- Behaviours of staff. This means teamwork and trust between people;
- How people communicate. This means how people talk to one another;
- Psychological safety. This means how safe people feel to speak up;
- How organisations work. This means people having the same goals; and
- Involving those who use services. This means listening to the voices of people who use services to help make decisions.
2. What are the enablers and barriers to developing and sustaining good safety culture?
Factors that can help to support good safety culture include:
- Leaders who are open to feedback so teams feel that they can speak up;
- Ways of working where everyone can express their needs and have their voice heard;
- Having mentors and chances to discuss safety more informally;
- Having ways to report when incidents occur and learn from them; and
- Using measures to understand more about ways of working, including staff experience.
Factors that can hinder good safety culture include:
- Staff tiredness from shift work;
- Staff members feeling that there are rules being imposed on them;
- A lack of clear expectations, responsibilities and standards;
- High staff turnover that means that good ways of working can be lost;
- When there is a fear that staff will be blamed;
- Staff feeling alone; and
- Lack of training and qualification opportunities, particularly within social care.
3. What evidence is there of good practice in the respective health and care sectors (nationally and internationally) of safety culture?
Three examples were looked at in the review. One area made safety culture a priority. To do this, they made sure that they were leading by example. They undertook training. This made their managers feel empowered.
They changed how they spoke to staff. This reduced worry about being blamed for incidents.
By improving safety culture, they saved around £2.5 million. This saving was made as they were able to reduce suspensions. They also reduced disciplinary activity, whilst employing more staff.
4. Where are the areas of strengths and weaknesses within current research?
Most of the research on safety culture comes from hospitals. Less research has been done beyond that.
Learning for CQC
It will be important for CQC to agree on a definition of safety culture. This should cover the three settings in this report. Hearing from different voices will help with this. Voices could include staff and people who use services. This could help CQC agree a definition for their regulation.
CQC has a chance to bring together learning relating to good safety culture. They work closely with services as part of their regulation. By bringing together the learning from this, CQC can collate case studies.
Conclusion
There are seven concluding remarks in relation to good safety culture below. How CQC may consider these going forward are described.
1. Safety culture is: Poorly defined across the different settings.
CQC could: Hear from different voices to understand what they think of good safety culture.
This means: A definition can be agreed.
2. Safety culture is: Reliant on leaders who are open to feedback so that teams feel supported to speak up.
CQC could: Look to understand how teams feel comfortable to speak up.
This means: Safety culture can be captured in how CQC inspect services.
3. Safety culture is: Supported through equal partnership. This means leaders, staff and those who use services.
CQC could: Hear from different voices to understand what they think of good safety culture.
This means: How CQC inspects services will gather multiple views of safety culture.
4. Safety culture is: Enabled through mentors and informal ways to discuss safety.
CQC could: Describe these as examples of good safety culture. They can also explore informal ways to support safety culture.
This means: CQC considers some of the “harder to see” ways of working.
5. Safety culture is: Likely to look different in different places.
CQC could: Consider this when understanding what good safety culture looks like.
This means: Safe care can be provided that is appropriately.
6. Safety culture is: Dynamic and can take time to develop.
CQC could: Recognise that some inspection approaches only capture a moment in time.
This means: Different methods could be considered. This may include short check-ins taken at different times.
7. Safety culture is: Not supported by many examples of how it can be cultivated.
CQC could: Undertake research to understand examples of good practice to share more widely.
This means: CQC can remain true to their strategy. They can help improve safety through the sharing learning. This can include examples of good practice.
Considerations for future research
Areas for future research include:
- Focus on what safety culture means in adult social care, and primary and community care;
- Understand the key parts of good safety culture;
- Map safety culture against the quality statements in CQC’s single assessment framework;
- Understand how the regulator does, or can, promote good safety culture;
- Explore how to measure safety culture over time as it develops;
- Understand more about what makes safety culture good in one area and how this may be different from another; and
- Explore what good safety culture looks like for those who use services.