I went to the NIHR SafetyNet Organisational Culture working group meeting in Birmingham on a cold day in January. I wanted to learn what “organisational culture” means and how it links to patient safety.

So, what is organisational culture?
After listening to researchers from different PSRCs, I learned that organisational culture is basically how people at work get along. It includes the relationships between colleagues, managers, departments, services and different job roles.

How does this affect patient safety?
The way people treat each other at work can directly affect the care patients receive. If communication and relationships between teams are poor, things can go wrong.
For example:

1. A patient might be sent home from hospital, but no one tells their family or carers, so no one is there to meet them.
3. A family may still be waiting for a call to say they can collect their loved one, only to find out the patient has already been taken home by hospital transport.

But when communication and teamwork are good, patients get much better care.
For example:

1. Maternity staff might tell new mothers about breastfeeding support available in their community.
3. If an older person is having surgery, hospital staff may work with community care teams and family members to plan what help the patient will need at home.

The biggest thing I learned

If staff are unhappy, feel unappreciated, experience bullied, or feel insecure in their jobs, this can lead to poor communication and bad relationships at work. This can then cause poor-quality services, lower standards of care, and higher risks to patient safety.

But if staff feel happy, valued, and supported, they are more likely to work well together. Good relationships between teams mean better services, higher standards of care, and safer experiences for patients.

Dr Matthew Cooper, NIHR Newcastle PSRC Safer Integrated Health and Social Care Environments, Research Associate

Broadening My Understanding of Organisational Culture

Attending the organisational culture working group helped me to broaden my understanding of what organisational culture truly represents. Initially, I viewed workplace culture mainly in terms of supporting staff wellbeing and keeping people happy and healthy at work. Through the discussions, I realised how strongly organisational culture also influences patient safety and the consistent delivery of high-quality care.

Exploring the Ambition of the 10‑Year Plan

The working group explored the ambition of the 10-year plan, which is expected to drive change both during the next 10 years and for the future beyond. This however highlights some key risks:

• That pressure to deliver quickly could lead to rushed decisions,
• Missed input from some disciplines (implementation science for example), or
• Action being taken without full consideration of the plausible impacts (for example removing resources from one service to fund a new idea).

A strong emphasis was placed on transparency of quality of care, including empowering patients through greater voice, choice and access to information. This was balanced alongside clearer accountability and stronger incentives for high-quality care. I was particularly struck by the challenge of double running costs, where services must continue to operate while resources are reallocated, and the importance of deliberately creating time for safety within this context.

Reaffirming the Core Purpose of Organisational Culture

Overall, the working group reinforced that the core goal of organisational culture is to support patients, underpinned by robust checks and balances, compassionate leadership, and a shared commitment to quality and safety at every level of the system. As a team at the NIHR Newcastle PSRC, this is something we are all hoping to reflect on and take forward in our research.

Learn more about the NIHR 10 year plan.

Steve discussed several barriers for patients accessing care, such as language and language style, communication that isn’t just about language (e.g., neurodiversity, sensory needs, memory, processing speed), physical disability, diagnostic overshadowing and hypersensitivity (e.g., to sensory stimuli, environments, noise, smells). These may mean that reasonable adjustments to consultations are used; for example, longer appointment times, quieter environments, visual prompts, alternative formats, consultation breaks or bringing a support person to accompany.

Steve shared with us some very impactful real-life examples of people he has provided care for who have required reasonable adjustments, and demonstrated what it means to go the extra mile in delivering person-centred care.

He summarised that reasonable adjustments are not something necessarily taught within university or professional training but are central within professional capability. Being aware of additional needs, asking patients what they would prefer and anticipating barriers and how to act on them allows us to demonstrate humility and advocate for the best possible outcomes for our patients.

It was a very stimulating and thought-provoking session, and it was great to see a big audience of attendees, spanning undergraduate Pharmacy students, postgraduate students, members of the NIHR Newcastle PSRC, wider University network and clinical colleagues from Newcastle upon Tyne Hospital NHS Foundation Trust.  The talk provided valuable insights that we can apply not only in our current roles but also take with us throughout our future careers. Engaging with reasonable adjustments in consultation settings may allow us to be better equipped to promote person-centred care to diverse, underrepresented patient groups.

Thank you, Steve!

One reflection that stayed with me came from a discussion about adoption and breaking cycles of poverty and violence. Even in systems that often feel broken, there are ways to create safety and opportunity through compassion and action.

Patient safety research considers various matters of life, death and health. These are not any academic topics. For many people, these are experiences they have lived through and are living with.

Before I started my research training, I became a practitioner. Mental health occupational therapy taught me a lot about healthcare and relationships. I learned that it is wise to listen to patients. Two different people can have the same condition, but completely different experiences. I also learned that it is caring to have difficult conversations. At its best, healthcare is about moments when a person in pain gets to talk with someone who is wise and caring. Both the patient and the practitioner use their voice, both listen, both learn.

Now I am learning to research. I have clear boundaries between how I engage with people as a researcher and as a therapist. There are great differences in how to build and navigate relationships in each role. As different as it is to show up as a researcher and as a practitioner, there are some similarities. At its best, also research is about people having good conversations. Researchers and people with personal experience get together to speak, listen and learn.

In my doctoral research, I work with a group of people who I have met through my previous projects. Different group members have personal experiences to share. Some know how it feels to live with addiction, and how it is to recover. Some have been family carers for someone with mental health problems. The common ground is that we all have a strong idea on what mental health support is at its best and at its worst.

We all bring with us our own reasons and motivations to do our bit in research:

Joanne: I want to improve things for others. I want to make positive, long-lasting change easier for everyone: professionals, policymakers, patients, families.

Haley: I want people’s voices to be heard by those who make big decisions at the higher levels. Research is a vital help.

Domna: I research because I want to understand how health systems can grow in wisdom and care. In this group, I can test my ideas and connect with practice memories.

Carol: I want to share my lived experience as a carer by helping with research and use it to help make change for future generations. 

Together, we work with clear ground rules. One person speaks at a time, everyone listens. If someone shares a personal story in the room, it stays in the room. We agree and disagree with uncompromising respect. Honesty is essential and expression is free – we can swear, but not at each other.

While we keep the conversation flowing, we get things done. We have spent time talking through the logic behind the project. We have developed information sheets for research participants. We have thought through scenarios that could bring up ethical challenges. We prepare to make sense of data together in the next stages of the research. We have gathered ideas on who to connect with in the later stages of the project, to share findings and learning.

We keep the conversation alive to catch ideas and build new understanding – of healthcare and of each other. We can all agree that hope lives where people sit around a shared table and speak their minds.

As part of a research project funded by the National Institute for Health and Social Care Research, Professor Hamde Nazar and Dr Evgenia Stepanova explore what happens to patients during the transition from hospital to home. In this video, they highlight the essential role of involving patients and the public through meaningful PPIE (Patient and Public Involvement and Engagement).

To ensure a safe and inclusive space for open dialogue, the project established two PPIE groups—a women-only group and a mixed group—each meeting four times throughout the study. These conversations offered crucial insights into real experiences of hospital discharge, revealing gaps in current research and shedding light on challenges that patients regularly face, such as feeling “in limbo”—with limited information, no clear point of contact, and uncertainty about available support.

Hamde and Evgenia reflect on how these contributions shaped the research and deepened its relevance and impact.

Programme Development Grants award NIHR205674 A Pre-implementation Study to develop and test an Integrated Discharge Intervention (PreSIDInt study)