Many of the failings of Mid Staffordshire NHS trust were blamed on the culture within the service, similarly the abuse at Winterbourne View saw the culture word used to describe how and why abuse was allowed to happen. Blame on ‘culture’ is not limited to health and social care. The rail franchise fiasco last year was blamed on a culture of fear, and the banking crisis which sparked the current financial crisis is often blamed on the culture within those institutions.
Yet does blaming the culture in an organisation really solve the issue and what does it really mean?
The culture within an organisation is the result of the leadership, or lack of, and the way those in the organisation react to that leadership. What ensues is a group mentality that becomes self-perpetuating and, if it goes unchecked, something that descends to the lowest possible denominator and is often directed by dominance rather than leadership. Once embroiled within the group mentality it is far easier for members to dismiss personal responsibility and place all responsibility on the culture within the organisation.
It also makes it harder to challenge the group mentality. People fear being ostracised by colleagues, fear they may lose their job or, in extreme circumstances, fear particularly dominant individuals. Those who believe that something is wrong but fear to speak up eventually feel they have become complicate in the wrong doing, “I will be blamed because I did not speak up earlier”. Others will just ignore what they believe is wrong and reconcile it in their own minds by saying to themselves “that is just the way it is done here”.
The real blame is not on the culture of the organisation but on the leadership of the organisation and the lack of responsibility and accountability throughout the organisation. People in such cultures prefer to pass the buck about failings, blaming others or the policy framework they have to work in or, indeed, the culture of the organisation rather than being prepared to stand up and say I got this wrong. Those who set the tone for the organisational culture, including those in Westminster, must start to take responsibility for the organisations under their control, they must encourage accountability and they must ensure the culture of responsibility and accountability reaches right down through the organisation.
In social care we must be aware of and ward against the possibility of a lack of responsibility and accountability and promote effective leadership.
For example, multi-disciplinary working is common place now but we often hear of ineffectiveness because of people working ‘in silos’ (a jargon term I don’t really like) and the danger is everyone trying to work together defers leadership and responsibility to other agencies with the result nothing gets achieved and the only person to lose out is the person who needs joined up services.
Effective leadership, responsibility and accountability are the best ways to promote good practice and if we are to provide the best possible care services they are the things that need to be at the top of the Health & Social Care agenda.