• Pennine Care FT will aim to learn from errors without seeking to blame staff for honest mistakes
  • Just culture approach designed to get to root of what happened rather than focusing on individuals
  • Approach has already been established at Mersey Care Trust

A Manchester mental health and community trust has become the latest to attempt an organisation-wide just culture approach to learning from errors.

Pennine Care Foundation Trust has said it will aim to learn from incidents without seeking to blame staff for honest mistakes and to provide workers with support to speak up about issues.

The just culture approach aims to get to the root of what happened and why rather than the focus being on individuals.

A just culture approach has already been developed at Mersey Care Trust with help from expert Sidney Dekker, whose 2007 book Just Culture helped to launch the new approach to errors in complex systems.  

Pennine Care FT launched its new process at a special conference where Bill Kirkup, who has led a number of investigations into NHS failures, spoke about the factors he believes are consistently found in the culture of failing organisations.

The trust will apply a just culture methodology across its mental health, learning disability and community services in six boroughs in Greater Manchester.

The trust told HSJ it decided to act after feedback from staff that the previous approach did not feel fair and could be done better. The trust said the change was part of a wider piece of work around culture and values.

Clare Parker, Pennine Care’s executive director of nursing, healthcare professionals and quality governance, added: “We’re very excited to be one of the first in the country to launch just culture and I’m personally committed to making sure it’s a success.

“In addition to feedback from our staff, patients and others, we’re really keen to learn from national experts. I’m delighted Bill Kirkup could attend our launch event and share his vast expertise from some very high profile investigations.

“Changing a culture is not a quick and easy task. We are at the beginning of a journey that will have many challenges along the way, but also many exciting opportunities to improve patient care and create a better working life for our committed and hard-working staff.”

Speaking at the launch event, Dr Kirkup said: ”Healthcare is risky; it always has been and always will be. No one likes owning up to mistakes, and it’s even harder when people are harmed, but how we respond and learn from incidents is fundamental to good patient care.

“There’s no easy or quick fix, but a positive and open workplace culture, with trust and respect among colleagues, can help eradicate a blame culture.

“Much of this is encapsulated in just culture, which is why I am so pleased that Pennine Care is doing this.”