Safety from the top

How does a board director know clients of the service they govern are safe?

Well they don’t. Not really. They’re not there in the consult rooms, on the street where the health workers are, or in the group home at night when a client (participant, service user) goes to bed.

You don’t know what making an appointment is like or whether staff are kind and respectful when overwhelmed clients fall apart in service settings. You don’t know how staff respond to mistakes, treat breaches or analyse performance data. Not really.

But you can as a director, work hard to establish systems and processes that provide information, and if you’re lucky, insight. Most boards in the human service space, do that. Establish in partnership with the executive team a reporting regime that provides routine performance data, enabling an overview of relevant performance and, if you’re lucky, over time the ability to discern trends and monitor key aspects of service performance.

Directors also need also to learn to read the room, observe the conduct of staff in formal and informal settings and watch for tells. Defensiveness, reactivity, excessive sensitivity and rigid and tightly held boundaries.  Is this a culture in which you have an opportunity to gain insight?

It’s well established that what drives quality is culture. Which is good news for driving improvement, but harder to monitor from the board table.  Not however, impossible. Cultures that are diverse, do better. Cultures that value kindness and respect amongst and towards staff, show improved client outcomes. And most importantly risk is best managed in environments that accept mistakes, value transparency and reward disclosure.

So one of the best indicators of a culture that truly values safety, is one that shares errors, unpacks incidents and values dissenting voices. So, one way to test the quality culture of a service is bad news.

Does your system and executive team routinely and authentically disclose mishaps or areas of concern? Are you as a director able to name any of the worst things that have happened in your service setting of late?  Human service delivery is not fairyland. It is simply not possible for nothing to go wrong ever.

And what role can a director play in building this culture? How are executives who present adverse information treated? How much time are the team spending on busy work that could  be better put to authentically exploring client journeys and experiences?

Are there genuine mechanisms for service users to disclose their experience? Clients have powerful reasons to not criticise or challenge providers. We need sophisticated  approaches if we really want to know - not that they received what we provided but more so, what they needed and whether there was a gap between those things.

Organisations that really want to assure quality have a challenge. They need to balance all that is required of them in meeting standards - audit, report, data collection - the myriad of statutory obligations. And they also need to be creatively committed to innovative methods of discerning what the everyday experience of service users is actually like and how that might be used to build and improve practice. They have to do this in a way that makes clear that staff and board are one team when it comes to building a  quality culture.

Blame, unreasonable expectations and demands, and excessive bureaucracy, will kill the will to live in  people already showing up to do a difficult job. The tone really is set from the top and it is okay to assume good will,. It greatly enhances the chance of together producing something good.    

Mārama Group works with organisations keen to learn from bad news and is committed to learning from those who know best. Those that receive and deliver the service.

Quality and what makes it

How effective is your organisation in ensuring the safety of your people? This question has taken on a new meaning over the last few years for two reasons. Firstly, because the obligations to provide safe workplaces have expanded and secondly, because the threats and hazards in workplaces have changed significantly.

The days when it was enough to think about manual handling, safe equipment and spaces have passed. These days we need to add to those types of risk - psychological safety, threat of intimate partner violence, cyber crime, climate change and political violence to name a few.

The organisational approaches required to keep people safe have changed, and our policies, plans and preparations need to as well. We need approaches that recognise that threats can and do come from within, and that the types of adverse impacts on teams - even in peacetime settings - can be catastrophic.

Take for example, intimate partner violence. In Victoria, five women were murdered by someone known to them in the past months. Many of those women will have had prior incursions of the perpetrator into workplaces, incidents that threatened not only that woman herself, but also her friends, colleagues and clients. Think how often this behaviour plays out in carparks, schools, health care settings and at work. This presents a threat not just to that woman but to clients and other staff. recognising this epidemic, workplaces today need to think about, plan and prepare for this type of scenario. There is a good chance that events like this are not on your register of risks. Or even if they are, there is likely no meaningful plan to manage a hostile threat of this type.

The other big change is climate related adverse weather events, events which can severely impact colleagues availability and well being and significantly threaten an organisation’s business continuity.

Have you given thought to what you would do if significant numbers of staff were unable to make it to work simultaneously, or worse, found themselves without adequate housing for an extended period. These types of eventualities are increasingly common. Many households, after natural disaster, are finding themselves without housing for months on end, or in a constant state of heightened anxiety as they watch for threatening fire warnings or clean up after floods.  The impact on your organisation too can be profound.

On the cyber front, the work home boundaries are blurring, an employee who experiences identity theft may unwittingly expose the whole organisation to threat actors. Ensuring that staff are aware of contagion risks and disclose relevant events are contemporary risks that organisations policies, codes and contracts need to address.

What these different scenarios have in common is that they are all features of the world we live in - right now. The challenges of the world are moving quickly. What seemed like a good plan five years ago may not meet the challenges of today. One of the greatest challenges for organisations is making sure that systems that have been in place for a long time are fit for purpose, in the context of the poly crisis.

Mārama Group work with organisations who have recognised the need for systems to be both future and present capable.

We recommend an evidence-based refresh, building on the experiences of others who are right now getting to grip with these challenges real time. - learning from those who have lived through the unexpected and unplanned for.  There is great business continuity value in partnering up with another group of similar scope and scale and planning to provide back up to each other if the worst happens.

Refreshing our thinking about the type of issues that might derail your organisation is key to being diligent and as prepared as possible.