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.