The Care Quality Commission’s (CQC) recent inspection report concerning the South East Coast Ambulance Service (SECAS), provides a thought-provoking assessment of organisational culture.
Care providers regulated by the CQC should take note of the report’s findings. However, we believe the outcome is relevant to all organisations, including charities and housing associations, as we have observed an increased focus on culture across all regulatory bodies.
After several whistleblowing concerns were raised regarding the culture and leadership at SECAS, the CQC opened an inspection into the service. The complaints related to bullying and harassment, inappropriate sexualised behaviour, employees raising concerns which were not addressed and cultural fear of speaking up amongst employees.
The CQC’s inspection found 'high levels of bullying and harassment, inappropriate sexualised behaviour and a high number of open grievances', alongside, 'low levels of staff satisfaction and high levels of stress and work overload.'
As a result of the inspection, SECAS’s leadership was rated inadequate. Subsequently, the Chief Inspector of Hospitals has recommended to NHS England and NHS Improvement that SECAS be placed into the Recovery Support Programme. The CQC has also suspended the overall and key question rating for SECAS, whilst they carry out checks on locations registered by them.
The CQC’s findings reinforce the importance of culture in an organisation. What is notable about the inspection report is that the focus is almost entirely on the bullying culture’s impact on employees, rather than on patients directly.
It is clear the CQC recognises the effect an organisation’s culture has on its workforce and the subsequent link to the quality of care provided. For example, situations where employees do not feel comfortable reporting concerns about medication or safeguarding incidents.
Increasingly, we are witnessing issues with organisational culture being integrated into regulatory proceedings.
- In our blog on the prosecution of Aster Healthcare for corporate manslaughter, we discuss the significant concerns raised over the treatment of whistle-blowers by the care provider. This case demonstrates that culture is key for service user safety. Operational staff must be engaged and encouraged to raise health and safety concerns and know that their concerns will be properly and fully considered.
- The Charity Commission is also placing more emphasis on organisational culture. This is demonstrated by their Inquiry report into the Royal National Institute of Blind People and subsequent regulatory alert to similar charities after they expressed concerns over closed cultures and failures to report safeguarding matters. Our e-briefing on the Inquiry report is available here.
- Research in the social housing sector has highlighted the link between inclusive organisational cultures and tenant engagement. This has a notable impact on ensuring staff and residents collaborate on important regulatory issues such as building safety.
- We have also seen the Health and Safety Executive increasingly focus on mental health and wellbeing in the workplace. See our blog here.
Good organisational culture needs to start from the top. The Health and Safety Executive have a useful page on the importance of organisational culture and how to cultivate a learning culture. This involves avoiding a culture of individual 'error' and ‘scapegoating' and instead addressing deep-rooted organisational problems identified.
"“But while staff were doing their very best to provide safe care to patients, leaders often appeared out of touch with what was happening on the front line and weren’t always aware of the challenges staff faced. Staff described feeling unable to raise concerns without fear of reprisal - and when concerns were raised, these were not acted on."