The National Health Service (NHS) has, for over four decades, been beset with numerous ‘scandals’ relating to poor patient care across several diverse clinical contexts. Ensuing inquiries proceed as though each scandal is unique, with recommendations highlighting the need for more staff training, a change of culture within the NHS based upon a ‘duty of candour’, and proposed criminal sanctions for employees believed to breach good patient care. However, mistakes reoccur and failings in patient safety continue. While inquiries describe _what_ (...) went awry in each case, questions of _how_ and _why_ such failures came to be remain unanswered. Psychology has a role in answering these questions. Applying psychological theory can guide an understanding of the _causes_ that lead to catastrophic failures in healthcare settings. Indeed, what is often neglected in inquiries is the role of human behaviour in contributing to these failures. Drawing upon behavioural, social and cognitive theories, a psychological analysis of key factors, typically present in clinical contexts where serious failures of care occur, is presented. Applying theory and models from the field of psychology can guide further understanding of the precipitants to poor care. (shrink)

Evidence exists that the UK National Health Service has had, over many years, persistent problems of negative and intimidating behaviour towards staff from other employees. The evidence also suggests the organisational responses to negative behaviour can be inadequate. A conceptual model of organisational dysfunction was proposed to assist in explaining those responses and the overall culture in the NHS. Through research this model has been tested. Based upon the findings, an extended and developed model of organisational dysfunction is presented. A (...) qualitative approach was taken to research the organisational responses to negative behaviour, and the reasons and motivations for those responses. Forty-three interviews and six focus groups were conducted. There seem to be “islands” and “pockets” with a positive culture; however, the generalised evidence suggests the NHS is systemically and institutionally deaf, bullying, defensive and dishonest, exhibiting a resistance to ‘knowing’, denial and “wilful blindness”; a dysfunctional, perverse and troubled organisation. Totalitarian and Kafkaesque characteristics are identified. The NHS could also be described as a coercive bureaucracy and under certain definitions, a corrupt entity. The NHS appears to be an organisation with a heart of darkness; a “self perpetuating dysfunctional system”. There may be widespread “learned helplessness”. It seems to be a “good news factory”, rejecting and hiding any “bad news”; retreating from reality. The NHS appears to have “lost its way” and its focus/purpose as an institution. The dysfunctional organisational behaviours manifest in the NHS need to be addressed urgently as there is a detrimental, sometimes devastating, impact on the wellbeing of both staff and patients. The NHS needs to embrace an identity of being a listening, learning and honest organisation, with a culture of respect. (shrink)

This study articulates the relational constituents of good care beyond techno‐rational competence. Neoliberal healthcare means that notions of care are readily commodified and reduced to quantifiable assessments and checklists. This novel research investigated accounts of good care provided by nursing, medical, allied and auxiliary staff. The Heideggerian phenomenological study was undertaken in acute medical‐surgical wards, investigating the contextual, communicative nature of care. The study involved interviews with 17 participants: 3 previous patients, 3 family members and 11 staff. Data were analysed (...) iteratively, dwelling with stories and writing and rewriting to surface the phenomenality of good care. The data set highlighted the following essential constituents: authentic care: caring encompassing solicitude (fürsorge); impromptu care: caring beyond role category; sustained care: caring beyond specialist parameters; attuned care: caring encompassing family and culture; and insightful care: caring beyond assessment and diagnosis. The findings are clinically significant because they indicate the importance of nurse leaders and educators harnessing the potential capacity of all healthcare workers to participate in good care. Healthcare workers reported that participating in or witnessing good care was uplifting and added meaning to their work, contributing to a sense of shared humanity. (shrink)