I had the very great pleasure of speaking to a group of masters students last week. They were all nurses and midwives, some from the NHS and some from the private sector, studying leadership at a university in London. We talked about leadership and community, bonds of trust, drawing on Julian Stodd’s work on social leadership, with great emphasis on the core skills of leadership…those of humility, compassion, equality and fairness.

Interestingly, we got talking about consequence. It became clear, that the people in the room were quite simply afraid to speak up for what is right. They felt that they would not be listened to because of their grade…they felt that what they said didn’t matter. One person even had a terrifying, yet depressingly familiar story of whistle blowing and consequence; in her quest for patient safety, she had been the subject of frankly illegal processes to ‘get her out’. The unit she had been concerned about was closed down, by an external body, many months after she had repeatedly raised concerns about it, and she was removed from her position. The Directors who were responsible, also left that Trust, but reappeared elsewhere, seemingly unscathed, in board positions. It may be, and I sincerely hope it is, that these individuals have learnt from their mistakes, but it is a stark reminder that power feels no consequence, and junior people are scapegoated, in what is still a very hierarchical culture.

This happened after the Francis Report, after the fit and proper persons test was brought in, and after freedom to speak up, and the duty of candour and even revalidation for nurses came about, these formal attempts to control and dictate the improvement of culture. I have heard just this week stories of destructive subversion of the system of revalidation by senior nurses. Not a ‘stand up for what’s right’ subversion to disrupt and innovate, but a misguided lack of insight, that somehow doesn’t see the connection between nurse competence and patient safety.

So, my conclusion from this is that although the formal system is providing recommendations, legislation and rules to support doing the right thing, the culture is not changing…probably because recommendations, legislation and rules are not the things that change culture.

The people change the culture, the actions of the people, not the values on the wall, the aspirations, but the way people behave on a daily basis. The Directors referred to above, I’m sure, didn’t intend to cause harm…but the world does not judge us by our intentions, it judges us by our actions, or inactions. To paraphrase Julian Stodd, our reputation, and our subsequent social authority, is based on our actions over is how we build trust and how we lead, and how we lead and behave is how we influence culture. One individual at a time.

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