How the CQC can build a safety culture

A safety culture is the outcome that organizations reach through a strong commitment to acquiring necessary data and taking proactive steps to reduce the probability of errors and the severity of those that occur.

(Merritt & Helmreich, 1997).

As the Care Quality Commission reforms and refocuses, there is a rare opportunity to build a safety culture in adult social care.

Safety cultures were first developed in aviation – another sector with high risk activities and potential for tragedy. In a safety culture, the emphasis is on understanding the factors that contribute to poor outcomes and that reduce them, rather than on looking for the person to blame. It is assumed that the pilot didn’t intend to cause a crash since s/he perished along with everyone else, so there must have been something else going on.

In social care, we tend to look for the human error, maybe because it is a human service. We are good at blaming, and at creating more and more guidance and governance to limit people’s scope. However, people don’t operate outside of a context. We tend to learn when there is a tragedy and, therefore, we tend to learn the same lessons – about the proximate causes. However, we don’t learn about enough the web of factors that lead up to these causes, and we don’t spend enough time examining the factors that prevent and reduce them. We don’t look at the whole system.

The opportunities and rationale for using a systems approach to build a safety culture in social care have already been identified. For example the Social Care Institute for Excellence advocates for a systems approach to safeguarding in its Guide Learning together to safeguard children: developing a multi-agency systems approach for case reviews (SCIE 2009).

The aim is to identify what the factors are that support good practice or that create an environment in which poor practice is more likely. This requires the following:

  • Firstly, to recognise that poor practice will happen and needs to be identified as early as possible so that it can be corrected or reduced
  • Secondly, to encourage everyone to speak up about problems at an early stage (this will only happen if there isn’t a blame culture)
  • Thirdly, to collate information about good and poor practice, and to analyse the factors that contributed
  • Fourthly, to use the analysis to prevent or reduce problems arising in the future by creating environments where poor practice is less likely and good practice is more likely.

This approach doesn’t mean that individuals aren’t accountable for what they do, but it does mean that why they do what they do is understood so that good practice can spread and poor practice become rarer.

The Care Quality Commission is in a unique position to use the systems approach to improve adult social care services in three ways:

  • CQC inspectors have the opportunity to understand what happens in a service, why it happens that way, and what the factors are that contribute to moments of good and poor practice
  • CQC staff can encourage everyone in the sector to report poor practice at an early stage by ensuring that it is used constructively to improve services, and by acting as role models for a learning culture rather than a blame culture
  • CQC can act as the central repository for information about the factors that lead to good and poor practice, and can disseminate learning to improve services. This is valuable knowledge for all providers, commissioners and, crucially, for people making a choice about services.

Merritt, A. C., & Helmreich, R. L. (1997). CRM: I hate it, what is it? (Error, stress, culture)

SCIE (2009) Guide Learning together to safeguard children: developing a multi-agency systems approach for case reviews.