Safety culture

Read how you can support your managers, staff and their trade union safety representatives to help create a culture that improves staff safety.

15 October 2019

Guidance from the NHS Staff Council's Health Safety and Wellbeing Partnership Group (HSWPG).

Culture forms the context in which people judge the appropriateness of their behaviour. An organisation’s culture will influence behaviour and performance at work.

A poor safety culture can cause accidents, injuries and ill health. A good safety culture can reduce injuries, may prevent injuries and improve staff health and wellbeing. This information provides a signpost to documents that can support managers, staff and trade union safety representatives to help create a culture that improves staff safety.

This Health, Safety and Wellbeing Partnership Group (HSWPG) guidance is written from the perspective of staff safety and all four countries of the United Kingdom have worked to improve patient safety. As recent NHS research has demonstrated, there are clear links between improved staff experience and better care for patients.

Below is a guide on how the four main influences can be applied to create a good safety culture in the NHS. 

  • Managers should:

    • be visible, regularly visit teams and departments and ask positive questions about health, safety and wellbeing
    • lead by example, so their actions are consistent with what they expect from their staff
    • acknowledge and give praise where health, safety and wellbeing are well done. This helps to reinforce good practice so that they become habits
    • listen to suggestions and concerns of staff and trade union (TU) safety reps, it is the people doing the job that will often know most about its hazards and risks and how to prevent them
    • be methodical over time and work to a plan
    • follow the principles of plan, do, check and act outlined in Successful Health and Safety Management HS(G)65 and incorporate this into their health, safety and wellbeing vision.
  • Good communication between all levels of employees, with input from TU safety representatives, is a pivotal part of a positive culture. Questions about health and safety should be part of everyday work conversations and management should listen actively to what they are being told by employees and take what they hear seriously.

    In your organisation, consider whether the procedures for communicating between departmental areas and TUs are well defined and monitored. What arrangements are there for conveying information between shifts? How effective are they?

    A number of simple steps can improve HS&W communications in the workplace:

    • carefully specify what key information needs to be communicated
    • aim to cut out the transmission of unnecessary information
    • aim to repeat the key information using different mediums, e.g. use both written and verbal communication
    • allow sufficient time for communication particularly at shift handover
    • encourage two-way communication with both the giver and recipient of the information, taking responsibility for accurate communication
    • encourage the asking of confirmation, clarification and repetition
    • ensure effective communication channels with TU safety representatives
    • encourage face-to-face communication wherever feasible.
  • There must be working practices and rules for effectively controlling workplace hazards linked to risk assessments. Bad practices must be challenged but in the right way. Asking someone 'why did you do that?' immediately puts them on edge and in a position of being judged. A coaching methodology is a better way to encourage compliance.  

    Health and safety reps can also support managers and colleagues in encouraging safe practice.

  • It is widely recognised that a blame culture is counterproductive and encourages secrecy. For example, the Care Quality Commission has identified that learning from incidents and being honest creates a supportive learning culture, which is in the interests of both patients and staff.  The key here is transparency. Healthcare professionals have a duty of candor which means they must be open and honest with patients when something that goes wrong.   

    Similarly HSE has produced its own guidance, Reducing Error and Influencing Behaviour, which explains the different types of mistakes people make and how we can create an environment that allows people to learn from them. With health and safety incidents the aim should always be to identify the immediate cause, root cause and further action to stop the incident reoccurring, rather than looking for someone to blame. Disciplinary action is only appropriate for malevolent or grossly negligent actions or omissions. Involving health and safety representatives in serious accident investigations is seen as best practice.

    For more information, read the Successful Health and Safety Management HS(G)65 guidance.