Time and time again we hear, when considering failings within the health, police and social care services, that there is a culture where staff do not feel able to voice their concerns or bring challenge regarding the practices within the organisation.
“You go to senior colleagues with a problem, and you come away confused and anxious”.
“Clinicians raised concerns with senior members of the hospital and their lives were made very difficult by doing that”. (BBC and other sources)
These are quotes from Stephen Brearey, the lead consultant on the neonatal unit at the Countess of Chester Hospital.
Brearey was the first to raise concerns about nurse Lucy Letby who was found guilty of murdering seven babies and attempting to murder six others.
This case is relevant to our work as consultant clinical psychologists in two obvious ways: firstly, in terms of effective safeguarding practices, and secondly our work around the importance of psychological safety in organisations.
Raising safeguarding issues with colleagues or whistleblowing becomes even harder when the individual is not completely sure, the evidence is only partial, or something ‘just doesn’t feel right’.
And yet safeguarding relies on individuals voicing their concerns when things remain unclear, but there is a behaviour or data which may indicate a problem.
It is the piecing together of these partial bits of information that provides the clearer picture. If people wait to be sure of the whole picture, then failures and tragedies are much more likely to occur.
Yet, we must also be aware of our propensity as human beings to dismiss unwanted information and concerns, particularly when the information is unestablished, complicated and sensitive.
Being presented with information which is on a scale of inconvenient to the unthinkable is, at the very least, uncomfortable – and human beings like comfort.
We like stability, predictability and simplicity and can go out of our way to avoid challenge, change and messiness.
We have an over-simplified psychological shorthand that helps us to make quick decisions but misses nuance, complexity, and more unexpected events.
It works on generalisations and is subject to being influenced by the individual’s own assumptions or the current cultural assumptions. For example assumptions regarding the 'type' of person who is likely or unlikely to be a perpetrator of harm.
However, this can also lead to us being naive and blinkered, leading to what appear to be avoidable awful outcomes.
Over the past few months, we have heard many people query, ‘But why would she do that?’ and ‘I didn’t think that someone like her would do such a thing'.
Within leadership we often talk about the importance of psychological safety; which is a key aspect of high-performing organisations, where challenge, ideas and concerns are welcomed and encouraged in order to deliver the best outcome for the organisation, staff and clients/patients.
However, within an environment where risk-related issues, inter-dependent working, complex decision-making, and safeguarding are paramount, such as in health care, social care or educational settings, the ability of staff to feel able to speak up becomes even more essential.
This is true also of organisations such as the police.
So, if an organisation is trying to safeguard against accidental or intentional harm, managers need to be open to hearing about a worst-case scenario and avoid being dismissive an uncomfortable reality.
Prudent realism requires us to face unwelcome truths and tolerate significant discomfort.
So in the case of an organisation or team this means having both the policy and culture to encourage people to share their experiences, thoughts, concerns and objections.
And when they do, to really hear and consider what is being raised.
One of the key barriers to psychological safety is a perceived lack of interest by management, or a belief that what you raised will be dismissed or ignored, or even that your work life will suffer due to you having raised a concern.
Although the latter should not be an issue due to whistleblowing legislation/policies, it is regularly cited within reports as the experience of those who have raised concerns in many recent reviews of health care, the police and social care services, including the Letby case.
Leaders and leadership teams need to expect to hear there are problems occurring within the work of their team and organisation. If there are not problems being raised – in short, there is a real problem.
‘Toxic positivity’ where we all congratulate ourselves and one another on doing a wonderful job is something to avoid and often results in failing to see what is truly happening.
There are many things that can encourage this toxicity, including the influence of wider culture and systems, such as feeling pressure to show the outside world and professional bodies or regulators, that ‘everything is fine’ and no issues are occurring.
When the outside world is intolerant of problems and expects and demands near-perfection this results in a ‘nothing to see here' game face from leaders, it becomes harder for organisations or individuals to acknowledge issues and mistakes, which is necessary if we are to learn from them without catastrophic events happening first.
We have heard calls for the regulation of trust managers and legislation to protect whistleblowers. This may help provide protection to staff and the public, but without culture change the impact will be minimal.
Leaders must recognise that to truly foster psychological safety they need to value the act of speaking up and voicing a concern even when we do not agree, because it is the act of speaking up which is of real value irrespective of whether the concern is upheld or not.
Culture change is not easy but is possible, by making sure that from recruitment to exit interviews, ‘speaking up’ is valued, met with good faith, encouraged, and modelled.
By accepting that things will go wrong and sometimes significantly wrong, both the best and the very worst human beings are capable of and not avoiding this reality, we can help to avoid tragedy more often.
By Gill I’Anson and Sue Knowles, consultant clinical psychologists, Changing Minds Child and Family Services (CMCAFS) and Evolving Psychologically Responsive Leadership