Promoting partnership working in the NHS

Implementation of a just and learning culture - Mersey Care NHS Foundation Trust

The organisation

Mersey Care provides adult specialist mental health, addiction, learning disability and community services in North West England and beyond. Clinical services are provided across 80 sites around the North West, with c8000 staff serving a population of almost 11 million people.

The challenge

At the onset of the work in 2016, Mersey Care had a significant number of disciplinary cases and associated suspensions. This was problematic for safe service delivery and seriously affected the health and wellbeing of staff. The trust’s staff side chair had raised concerns about the detrimental impact on staff of the trust’s formal approach when mistakes were made, and further research found staff were reluctant to be transparent about their mistakes as they feared blame.

The aim

The aim of the work was to create an open and honest culture by asking what happened? instead of who is responsible? and to facilitate learning and improvement in patient and staff care and experience. As well as improving staff morale through the reduction in formal HR interventions such as disciplinaries.

The process

Trust and staff side agreed that something had to change and in partnership began to look for alternative solutions. Management, HR and staff side jointly addressed the initial stages of the disciplinary process, introducing a template which encouraged decision makers to ensure all appropriate information was gathered before deciding to instigate formal proceedings. The template also ensured the employee, who may be the subject of the investigation, could contribute information about what had happened or what had not gone as expected; deliberately avoiding terminology inferring something had gone wrong.

Just and learning ambassadors were also introduced; self-nominated employees who work throughout the trust to drive necessary cultural changes. The work of the ambassadors is steered by the just and learning culture committee, a partnership including ambassadors, organisational leaders and staff side colleagues. Policy framework and learning resources have also been developed in partnership to support staff and enable real learning.


Since the introduction of the changes there has been a notable reduction in disciplinaries at Mersey Care, with one clinical division seeing a 64 per cent reduction in disciplinary cases in 2016/17. The trust’s 2017 NHS staff survey results show statistically significant improvements since 2016 in the fairness and effectiveness of procedures for reporting errors, near misses and incidents. Staff confidence in raising concerns is currently standing at 74 per cent, 2 per cent higher than the national average for comparator trusts.

Addressing issues before they escalate has been a key factor in improving staff morale, together with significant improvements to the trust’s 72 hour review process, with staff  receiving feedback and learning being shared in a timely manner. Both staff side representatives and management endorse the positive impact of working in partnership to pave the way for a just and learning culture.

Top tips

  • Share good practice as part of business as usual.
  • Recognise there are several reasons why things may not go to plan; system issues, policy, training, environmental or human factors.
  • Patience; it takes time to build trust and improve staff morale.
  • Language; check policies and processes where language tends to be punitive rather than restorative.
  • Watch our movie 'Just Culture'

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