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I came across an article in The Times recently – ‘Toxic doctors put patients at risk, says NHS watchdog’ (November 18th 2023). It struck a chord with me.  Highly functioning teams consistently feel empowered and confident to raise concerns and admit mistakes. This isn’t happening within our health service.

The article focuses on the culture of silence within the NHS if mistakes are made and that ‘organisational reputation has been put above patient safety’. Rob Behrens who investigates complaints about the NHS in England said ‘what should be a collegiate, trusting environment is nothing of the kind’. He added that patient safety is being undermined by the ‘entrenched cultural problems in the NHS’. Having mediated for several clinical groups I have had first-hand experience of this destructive culture. Perhaps it’s a good thing that I’m being called to mediate more within this sector, as the issues are now being recognised and solutions are being explored.  However, it feels like there is a long way to go.

Amy Edmondson is Novartis Professor of Leadership and Management at Harvard Business School. Whilst studying for her PhD, Edmondson focused her study on hospital wards. She expected to find that higher-performing teams made fewer mistakes. Instead, she found the opposite, that better teams report higher error rates, not lower ones. She discovered that the better performing teams were those who felt more willing to admit their mistakes, the culture within the team provided a psychologically safe space for them to speak openly and honestly, without retribution. Her book ‘The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth’ (Wiley 2018), is worth reading.

The Times Health Commission, which is referenced in The Times article, is a year-long inquiry that will make recommendations for reform within the NHS. I wonder whether conclusions to this inquiry will include recommendations from Edmondson’s work. To create a ‘collegiate, trusting environment’ leaders need to create a psychologically safe space, set the stage so everyone understands the potential risks, invite engagement, ask good questions, listen and act on the mistakes staff are willing to talk about.

I will be watching with interest as Times Health Commission reaches its conclusions.