The recent revelations about the workplace culture at the Nursing and Midwifery Council (NMC) in the UK have left many, including myself, deeply saddened. The environment, riddled with psychosocial hazards, has highlighted the urgent need for change not just in the UK, but globally.
The Power of Legislation
Here in Western Australia, we have moved into a new era with the introduction of the Work Health and Safety (WHS) Act. This legislation empowers authorities to hold employers accountable for providing a safe working environment. It’s important to clarify that this doesn’t equate to employees having carte blanche in the workplace or never experiencing discomfort due to personal values clashing with those of the organisation. Rather, it ensures that those in power can be held accountable for the physical AND psychological safety and wellbeing of their employees.
NMC’s Commendable Efforts
Despite the challenges, the NMC has taken commendable steps towards improvement. An Equality, Diversity and Inclusion (EDI) advisor is set to join the Executive Board, enhancing its diversity and aiding in decision-making. The Freedom to Speak Up Guardian is now available for colleagues to voice their concerns and receive independent support.
Listening circles, facilitated by trained professionals, have been established, providing a platform for open discussion and decompression about issues highlighted in the report. Investments have been made to bolster psychological safety within teams, starting with the Professional Regulation directorate.
Support is being extended to colleagues working on sensitive casework, offering professional counselling from trained psychologists. The budget for learning and development is being doubled, with improvements in leadership, line management, safeguarding, and casework expected to roll out by October.
An external EDI partner is conducting a review of the EDI learning and will make further recommendations to enhance mandatory training. Work is actively underway on a new behavioural framework to aid recruitment, development, career progression, and performance management, with a planned launch in September.
A Closer Look at AHPRA
In Australia, the Australian Health Practitioner Regulation Agency (AHPRA) has faced similar accusations of a poor workplace culture. Allegations of under-resourcing, bullying, and harassment within the organisation have been made public, leading to questions about the transparency of AHPRA’s operations.
AHPRA’s primary role is to protect the public by ensuring that Australia’s registered health practitioners are suitably trained, qualified, and safe to practise. However, the allegations, if true, could affect the quality of work and safety at many levels.
Since the allegations were made public in January 2023, several actions have been taken to address the issues raised. An internal briefing from 2020 suggested that the results of a 2018 staff survey led to the engagement of four external consultants to assess the issues. This indicates that AHPRA has been proactive in seeking external expertise to help address the concerns raised by its staff.
However, the specific actions taken by AHPRA in response to the allegations of a poor workplace culture are not detailed in available sources. This includes the National Health Practitioner Ombudsman (NHPO) which handles complaints about AHPRA and has the power to conduct 'own motion' investigations without a specific complaint being received. The NHPO commenced a review into AHPRA's vexatious notifications framework in July 2022, which is widely anticipated by many practitioners.
As we move forward, it’s crucial that we continue to hold these organisations accountable while also acknowledging the vital role they play in the provision of safe and quality healthcare in Australia. Let’s continue the conversation but remember to do so with respect and understanding for the important work these organisations do.

In the quest for a safer and more productive workplace, incident reviews play a pivotal role. However, the effectiveness of these reviews hinges on the approach taken. A just culture, which focuses on learning and improvement rather than blame, is key to this process. This article explores strategies to ensure a just workplace culture through best practice incident reviews.

Involving Frontline Staff: The Key to Insightful Incident Reviews
Frontline staff are the eyes and ears of an organisation. Their direct involvement in daily operations provides them with unique insights that are crucial for an effective incident review process. Here are some strategies to involve frontline staff effectively:

1. Include Frontline Staff in the Investigation Team: Frontline staff who are directly involved in the incident or who work in the area where the incident occurred can provide valuable insights. They should be included in the investigation team.
2. Conduct Interviews: Interview frontline staff who were involved in the incident or who might have relevant information. Ensure these interviews are conducted in a non-threatening manner, focusing on fact-finding and learning rather than blaming.
3. Encourage Open Communication: Create an environment where frontline staff feel comfortable sharing their views and experiences. This could involve assuring them that the focus is on system improvement, not individual blame.
4. Provide Training: Train frontline staff on the purpose and process of incident investigations. This can help them understand their role and the importance of their input.
5. Feedback Loop: Share the findings of the investigation with the frontline staff and involve them in developing and implementing recommendations. This can help ensure the changes are practical and effective.
6. Regular Meetings: Hold regular meetings with frontline staff to discuss ongoing issues and potential solutions. This can help identify patterns and trends that might not be apparent from individual incidents.

The goal is to create a culture of safety and continuous improvement, where everyone feels responsible for identifying and addressing system weaknesses. Frontline staff play a crucial role in this process.

Shifting the Focus: From Blame to Systems Approach
When dealing with management colleagues who tend to focus on blaming individuals, it’s important to shift the focus towards a systems approach:

1. Educate About Just Culture: Explain the concept of a just culture, where the focus is on learning and improvement rather than blame. Share resources or provide training sessions to help them understand this approach.
2. Highlight the Limitations of Blame: Point out that blaming individuals does not prevent future incidents. Instead, it can create a culture of fear that discourages people from reporting incidents or mistakes.
3. Promote Systems Thinking: Encourage your colleagues to consider the systems and processes that contributed to the incident. This can help shift the focus from individual blame to system improvement.
4. Use Data and Examples: Use data from past incidents to show how a systems approach can lead to meaningful improvements. Real-life examples can be powerful tools for changing mindsets.
5. Involve Them in the Process: Involve your colleagues in incident investigations and the development of action plans. This can help them see the value of a systems approach firsthand.
6. Seek Support from Higher Management: If necessary, seek support from higher management to reinforce the importance of a just and systems-focused culture.

Changing mindsets can take time and patience. Stay consistent in your approach and continue to promote a culture of safety and learning.

A just workplace culture is not just about avoiding blame. It’s about fostering an environment where everyone feels responsible for safety and continuous improvement. By involving frontline staff in incident reviews and promoting a systems approach, organisations can make significant strides towards this goal.

Learn more about a just, learning culture here: Home - Sidney Dekker