Understanding complaints: Adopting a just and learning culture

After receiving a high number of complaints about staff, Mersey Care NHS Trust adopted the principles set out by patient safety expert Professor Sidney Dekker and the idea of a ‘just culture’. 

Around 40% of staff were facing disciplinary action every year. Over 50% of these actions resulted in there being no case to answer. There were also indications during disciplinary meetings that some staff felt fearful of speaking up when things went wrong for fear of being blamed or punished.

Professor Dekker agreed to help Mersey Care design a ‘Just and Learning Culture’ pilot to support staff through learning and empower them to speak up when things go wrong. The new approach included conducting activities to engage more with staff and changing the language Human Resources used with staff to be more supportive.

The Trust also amended their disciplinary procedure by encouraging managers to investigate and understand the incident in question first, and for staff involved in incidents to contribute information during the disciplinary process.

The approach highlighted the importance of understanding what had gone wrong rather than seeking out the person responsible for individual mistakes. This included the circumstances and existing procedures that had led to serious incidents. 

The Trust’s new approach has led to a significant reduction in disciplinary cases. Although Mersey Care merged with another Trust and its workforce more than doubled between January 2016 and December 2017, the number of staff disciplinaries during this period reduced by 59%.

The pilot was also helped build trust among staff so that staff are encouraged to speak up when things go wrong. Issues can then be raised proactively in a more flexible and informal way. During 2018/19 the Trust received 338 formal complaints, compared to 415 in 2017/18 and 646 in 2016/17.

The Trust’s Annual Report highlighted how this improvement reflected their work on learning from complaints. It also showcased the work done by the Patient Advice and Liaison Team in resolving complaints without the need for a formal investigation. 

New NHS Complaint Standards 

We've been working in partnership to design a set of Complaint Standards for NHS staff. The Standards will provide a consistent approach to support frontline staff and help senior leaders to promote a positive culture that embraces learning from complaints.

 Find out more about the NHS Complaint Standards.


More good practice in complaint handling:

This case summary is also featured in the Making Complaints Count: Supporting complaints handling in the NHS report.