Learning

Learning is an essential ingredient to success in any environment, and is influenced by the elements within the EiC framework. Whilst it is essential to learn from adverse events and complaints, it is also important to share the learning from events that have produced positive outcomes. Learning is more effective within a caring and compassionate environment that promotes openness and transparency and welcomes staff and service user feedback.

The implementation of the EiC framework will promote an environment that flourishes through shared learning, it connects and influences people and develops their understanding.

EiC is committed to the development of a culture of learning across Scottish health boards. Following several NHS inquiries [i.e. Bristol Royal Infirmary Inquiry 2001 (88), Shipman Inquiry 2002 (89), Victoria Climbié Inquiry 2003 (90), The Vale of Leven Inquiry 2014 (1), Francis Report 2013 (2)], a culture of learning within the NHS has been prioritised (52). These reports proposed that the noted failures could not be attributed to individual healthcare professionals but rather resulted from systemic issues in which potential concerns were not communicated and learned from (91). The literature has identified several key areas for improvement within healthcare systems: developing a culture of psychological safety, encouraging continuous learning and reflection, and sharing knowledge across networks.

As highlighted by the Care Quality Commission (92) and Leonard and Frankel (93), a culture of learning is integral to psychological safety, and thus the ability for staff to report incidents and concerns. Through cultivating a culture of learning, healthcare systems can shift away from policies that perpetuate fear and blaming, where healthcare staff can raise issues without distress, and actions can be taken immediately to address the issue (93). There is evidence that some NHS staff currently perceive a lack of psychological safety within their teams, and thus report apprehension to point out mistakes or areas needing improvement (95). Within the EiC framework culture is a key element that promotes the facilitation of supportive teams and empowering staff to raise concerns.

Stinson and colleagues (91) emphasise that healthcare organisations must protect time for professional development so that staff may continuously learn and be up-to-date on the latest improvements related to care. Hospitals with high percentages of staff receiving job-relevant training, provided a better quality of care for patients and lower levels of patient mortality (52). However, as proposed by Stevenson and Moore (95), learning should be specified towards areas needing improvement. Through the CAIR dashboard, healthcare teams will be able to engage in reflective practice, identifying specific areas for improvement using the quality measures within the dashboard.

Critically, learning needs to occur across healthcare settings so that the entirety of the healthcare system can benefit, rather than keeping knowledge solely within local teams (95). EiC engages with stakeholders and staff across all of Scotland’s health boards, aiming to create a space where learning can be shared between teams to reduce inefficiency and improve care nationally. This aligns with a learning system that aims to accelerate the sharing of learning and improvement work across all care services. Through collaborative working, sharing good practice and signposting to training resources SPSP and EiC aim to encourage continuous learning at all levels, in every care setting.

Empowering people to be at the centre of their care and listening to them, their families and carers is a strategic priority for NHS Scotland and the Scottish Government. We are committed to developing a culture of openness and transparency in NHS Scotland that views feedback as a tool for learning and continuous improvement.

Scottish Government’s Response to the Vale of Leven Hospital Inquiry, 2015