Guiding lights for effective workplace cultures that are also good places to work

Abstract

Background: Working environments and relationships influence healthcare workers’ satisfaction and intent to stay, as well as service-user outcomes. With staff shortages a global issue, co-creation of effective workplace cultures that are also good places to work is more important than ever. Since our original research in 2011, a growing body of theoretical insights into workplace cultures has shown how complex it can be to develop them. We were curious about what staff felt works or what is needed. Aim: To develop a guiding theory with and for healthcare practitioners on effective workplace cultures in settings that are also good places to work. Methods: A three-phase study was used, based on principles of appreciative inquiry and realist evaluation. A blog generated initial interest, followed by a Twitter chat posing provocative questions. A series of Context-Mechanism-Outcome (CMO) configurations emerged and were presented to a new audience during an international conference. Endorsements and additions enabled further refinement of the initial programme theories, which were again presented for reflections during a second Twitter chat. Subsequent analysis resulted in a realist programme theory ready for further testing in practice. Findings/results: There are four guiding lights for co-creating effective workplace cultures in settings that are also good places to work: collective leadership; living shared values; safe, critical, creative learning environments; and change for good that makes a difference. When each is given adequate attention and all are combined, the ultimate outcomes include: high-performing teams that flourish and provide person- and relationship-centred care that is safe, effective and independent of the agency of specific individuals; and teams that develop effective partnerships within and across boundaries. Conclusions: Based on the voices of international frontline healthcare staff, we propose the retention of staff committed to providing care valued by staff and service users can be achieved by: collective leadership; living shared values; safe, critical, creative learning environments; and change for good as determined by those providing and experiencing care. Implications for practice: Healthcare managers, leaders and commissioners need to recognise and support microsystem culture development that staff and service users experience as good and safe Workplace culture development should be continuous, collaborative, inclusive and participatory, and driven by staff and service-user experiences, not top-down action planning and box ticking Responsive and person-centred leadership enables effective workplace cultures and collective leadership

The experience of staff utilizing data to evaluate and improve person‐centred practice: An action research study

“…The data also held strong relevance to practice as it was collected by the staff and service users at the micro level of care with the intention to evaluate and inform person-centred practice. These findings contribute to the growing body of evidence demonstrating that contextual data that are collected and used in a participatory and collaborative way by staff and service users result in flourishing and the development of person-centred cultures(Cardiff et al, 2020).Staff also outlined that these data provided unique and meaning-ful insight into nursing practice from the patient perspective which was different to other data sets regularly used in nursing. Historically, data collected about care delivery have seen the identification of patients in relation to their illness, gender, age and bed number, which diminishes the acknowledgement of personhood.…”

Co‐creating system‐wide improvement for people with traumatic brain injury across one integrated care system in the United Kingdom to initiate a transformation journey through co‐production

“…This involves growing carers as facilitators of change 31 and increasing the availability of relevant placements and career progression opportunities to develop the practice of health and social care professionals 30 . These learning cultures require skilled facilitators who can foster an approach to learning that recognizes the financial uncertainty and ambiguity within which the cultures must nevertheless flourish 6,29,30,32,33 . We suggest that ICSs will know if their services are right for people experiencing TBI if the co‐produced individual outcomes are met and system‐level indicators show reduced lengths of stay, admissions and re‐admission rates, referrals to mental health, criminal justice and substance abuse support services.…”

“…30 These learning cultures require skilled facilitators who can foster an approach to learning that recognizes the financial uncertainty and ambiguity within which the cultures must nevertheless flourish. 6,29,30,32,33 We suggest that ICSs will know if their services are right for people experiencing TBI if the co-produced individual outcomes are met and system-level indicators show reduced lengths of stay, admissions and re-admission rates, referrals to mental health, criminal justice and substance abuse support services. Getting this right across the system would not only have a positive impact on people with TBI, their carers and families but also on communities and society more generally.…”

Building safety cultures at the frontline: An emancipatory Practice Development approach for strengthening nursing surveillance on an acute care ward

“…These episodes reveal how members can safely support each other as they develop, innovate and transform their context. Frontline teams can learn to work constructively with uncertainty (Cardiff et al, 2020). Importantly, as normalised practice confronts transformation, teams need respectful, challenging, person‐centred relationships for growth.…”