Monthly Archives: June 2014

Staff at Scottish dental clinic lacked ‘most basic’ knowledge and endangered lives

Last week it was reported that a NHS dentist at the centre of an HIV scare re-used gloves and didn’t clean instruments. Inspectors found that staff had little or no training at two clinics run by Alan Morrison in Ayrshire and used the same gloves for multiple patients. Around 5,000 patients were alerted and offered HIV and hepatitis B and C tests.

This highlights yet another case for the NHS where safety breaches are putting people’s lives at risk and is something the NHS urgently needs to address. Following a number of high profile cases of patient neglect in recent years, the Berwick Review into patient safety in August 2013[i] said NHS staff are not to blame – in the vast majority of cases it is the systems, procedures, conditions, environment and constraints they face that lead to patient safety problems.

However, whether staff or senior managers are to blame at the Ayrshire clinic, it’s clear that even the most basic hygiene rules weren’t being followed, rules which even those with no medical knowledge would be likely to know. What went wrong and why were incompetent employees allowed to treat dental patients?

Whilst inspectors found that staff had little or no training, this error seems down not only to an error of judgement but also a lack of common sense. Over the course of 16 years and countless assessments, we have seen that up to 30%of any workforce, will unwittingly have a low enough level of understanding, to place the organisation (or their colleagues and patients) at significant risk.

The key to preventing incidences likes this in the future is a better understanding of human behaviour and ‘likely’ behaviour in workplace scenarios.

The NHS needs to put more stringent measures in place to assess employees and ensure they are competent and fit to practice; and are compliant with safety procedures.

Only by having a good understanding of their workforce competency and knowledge, and likely behaviour can the NHS have any chance of preventing serious breaches of patient safety in the future.



NHS World Leaders – but where is it exposed?

The NHS has been in the news for all the wrong reasons over recent years, so it was great to read this week that Britain’s healthcare system has topped a league table as the best out of 11 of the world’s wealthiest countries.

The ‘Mirror, Mirror on the Wall’ report is conducted by the US-based Commonwealth Fund and looks at the quality, efficiency, cost and performance of the US health system compared to ten other countries.

The UK ranks first overall, scoring highlight for quality of care, efficiency and low cost at point of service. The USA came last, as it has done four other times since 2004, and Switzerland was ranked second.

Whilst this is positive news, it’s still important to recognise that there are parts of the NHS that fall short of providing the excellent care it is renowned for worldwide and several NHS Trusts have been accused of severe patient neglect over the past few years.


A report by Professor Sir Bruce Keogh, the NHS’s medical director published in 2012 found that up to 13,000 people may have died ‘needlessly’ in NHS hospitals since 2005.

Last year The Francis Report into care failings at Mid Staffordshire Foundation Trust found senior managers had made serious errors of judgement, and failed to ensure that medical staff followed procedures properly, leading to safety breaches and high mortality rates.

To put things in perspective though, the NHS is a huge organisation. It employs more than 1.7 million people and of these just under half are clinically qualified, including, 39,780 general practitioners (GPs), 370,327 nurses, 18,687 ambulance staff and 105,711 hospital and community health service (HCHS) medical and dental staff.

Only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ more people. The NHS deals with over 1 million patients every 36 hours.

However, the NHS has changed in 65 years since it started and so have patient needs which have in part led to some of the problems its facing now. Factors such as an aging population, costs of new drugs and treatments and lifestyle factors, such as obesity are having a huge impact.

The Berwick Review into patient safety in August 2013 said NHS staff are not to blame – in the vast majority of cases it is the systems, procedures, conditions, environment and constraints they face that lead to patient safety problems.

The challenge, therefore for the NHS is that despite all the processes, procedures and training you could possibly provide; serious incidents that result in death or personal injury still happen.  Compound errors caused by a series of small, simple mistakes, breaches of protocol or procedure or simply due to the pressure and demands of the situation, occur far too frequently.


Broad-brush training and “tick box” compliance won’t evidence whether staff really understand how and why they need to behave in a certain way, or indeed if they will act as they know they should, when the pressure is on.

Understanding an individual employee’s level of competence, confidence and understanding is the next step for the NHS in addressing what has become widely known as Human Factors. It’s an area industries such as Rail, Airlines and Oil and Gas have understood and embraced for some time and one in which Cognisco has played a leading role.

We are committed to helping the NHS and the Health and Social Care Sectors more widely, as they grapple with this complex and challenging area.

Therefore there has to be measurement put in place to ensure all employees are compliant with safety procedures and NHS trusts need to have a good understanding of their workforce competency and knowledge in order to achieve this. To be effective this has to be implemented across the whole organisation. No small task, but crucial to ensure we continue to have an NHS we can be proud of.



Don’t let poor record keeping harm your employees and put your company at risk

When managing health and safety in your organisation having proper audit trails and record keeping is crucial.

It was reported last week there has been a rise in the number of employers’ and public liability claims brought before the courts where there is no record of the incident having taken place.

Where there is no paper trail and no evidence that an incident occurred, such as an accident or injury, it is up to the claimant to ‘prove’ that it occurred. This obviously then relies on the court deciding who to believe, the claimant or defendant.

Without concrete evidence, many courts are accepting medical records as confirmation or proof of injury. The problem here is that medical records generally don’t mention or go into any great detail about how or where the injury happened. Without any further evidence, many courts will rely on these medical records and rule in favour of the claimant.

So what does this mean for organisations? It means that without processes in place that ensure records are kept for all incidences and proper audit trails for everything, they are leaving themselves wide open to claims from disgruntled employees.

This is hugely risky, especially in industries where accidents and injuries can happen quite frequently. There is a great deal of legislation regarding what records must be kept, but all companies should have robust process in place for record keeping and managing risk, including audit trails, especially when it comes to managing health and safety processes.

Even if an accident or injury is minor it must still be documented. Without reporting and recording these events, companies are at risk of being sued for something that may not have been their fault. The consequences could be financial penalties as well as damage to their reputation and brand, so it’s clearly not a risk worth taking.


Health & Safety Magazine: Influencing Employee Behaviour

All workplaces have the potential to put the health and safety of employees at risk, but employee behaviour is often a major contributing factor too. Understanding that many injuries and deaths in the workplace can be attributed to human behaviour is important for any business seeking to improve health and safety standards, says Mary Clarke.

Companies can enhance performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture, organisation on human behaviour and abilities, and the application of that knowledge in the work environment.


Human behaviour is a contributory factor to workplace injuries and deaths and often a result of employees’ misunderstanding aspects of their role or making mistakes. In our 16 years’ experience of assessing workforce competence around the world, we have evidenced that around 30% of any workforce don’t fully understand key aspects of their role.

Last year, there were two rail disasters in mainland Europe. In Paris six people died and more than a hundred were injured in a high speed crash outside Paris in July and in Spain, just two weeks later, 79 people were killed in a crash outside Santiago de Compostela.


In the Paris incident, the driver was praised for his quick reactions that prevented more deaths and injuries, whilst in the Spanish crash, the driver was reported to be on the phone at the time of the crash and therefore was considered to be at fault.

So how do you gain an understanding about how employees ‘likely’ behaviour in any given work scenario can assist in the management and reduction of health and safety risks?


One effective way to do this is by regularly measuring how people perform and behave at work using situational judgement assessments that correlate people’s understanding and confidence. Such assessments provide insight into what an individual truly knows, how confident they are using their knowledge and highlight gaps in knowledge, as well as areas of high confidence – which is where potential risks lie. The gaps can then be addressed with targeted training interventions to improve performance and reduce risk.


This new approach to identifying and measuring People Risk is being adopted across many industries including Rail and Utilities, as well as in the NHS.


A leading NHS trust recently introduced such assessments in its obstetrics department to assess the competence and confidence of midwives and other clinical staff in a simulated training environment.

The Trust’s goal was to improve patient safety and reduce the number of serious case incidences. To achieve this, it needed a better understand of the training needs of medical staff as well as more insight into the effectiveness of its training and areas to improve.


A specialist online assessment tool was created to evaluate the performance of midwives and doctors in simulated acute clinical situations. Individuals were assessed in how they behave  – including the quality of their communication skills, their decision making and ability to spot risks, their handover to other colleagues, their approach to patient care and how they escalate situations. The assessments provided insight into the knowledge, likely behaviour and confidence of individuals and teams working in different scenarios.

One trainer at the Trust said: “Assessing an individual’s competency and level of confidence, helps weed out those ‘dangerous characters that don’t really understand things’. It also gives you the opportunity to spot somebody who isn’t lacking in knowledge but lacks the confidence to apply it.  You can target training to build knowledge and coach and mentor to improve confidence.”


This approach to assessing how people behave at work and identifying risks is being widely adopted in many industries where health and safety and compliance are critical. In the rail industry it is being used to ensure frontline staff such as drivers, engineers and signallers are complying with industry standards for health and safety; in the Utilities sector it is being used to ensure the safety of highway maintenance workers and in the catering and hospitality industries to ensure food safety standards are met.

In all examples, health and safety standards are compromised when people don’t behave in the right way. Having a way of assessing not only how competent people are, but how they behave in the workplace, and the ability to identity and eradicate risky behaviour can be a major factor in reducing health and safety risks.



Co-operative bank members need to better manage employee competence and behaviour

Assessments that examine employees’ behaviour and likely decision making should be part and parcel of working life, Mary Clarke says.

Co-Operative bank members need to better manage employee competence and behaviour

The Co-op bank was once revered for its ethical policies and low risk behaviour, when other banks were in crisis. However, following its near collapse last year, with losses of £2.5bn and the scandal surrounding its former chairman, Reverend Paul Flowers, the bank has been hitting the headlines for all the wrong reasons. 


In recent months, two independent reviews investigating the bank’s troubles were published, which highlighted a catalogue of problems. Sir Christopher Kelly, chairman of the Committee on Standards in Public Life released the ‘Kelly Review’ in April, and Lord Myners’ ‘Independent Review of Governance’ followed in May. The Kelly Review found that the bank had been run by unqualified executives, who had an “overly casual” approach to regulators, little grasp of risk and a tendency to turn a blind eye to growing problems despite the financial crisis. The report said that the group’s board failed to ensure that the Co-operative Bank consistently lived up to its ethical principles.


Lord Myners, former Treasury Minister and a former board director at the bank, agreed. He also went one step further labelling the board as “manifestly dysfunctional” and claiming its members lacked business experience. Myners’ proposals for reforms included the need to replace Co-op’s 21-strong board of representatives with a slimmed-down structure of professionally trained directors, and the creation of a new 50-strong National Membership committee to provide oversight of the top body.


One of the key challenges for the bank going forward is to get the recruitment of the new board members right, something which the bank has failed to do in the past.

In April 2010, the appointment of Reverend Paul Flowers as chairman of the Co-op bank was widely criticised because of his inexperience in banking. Mr Flowers was a man with limited banking experience and in a previous role as a trustee of the drugs charity Lifeline, he resigned in 2004 after allegedly filing false expenses claims. In May last year, the Co-op bank was found to have a £1.5bn black hole in its finances, which led to Flowers stepping down.


With a dubious track record and limited experience, why was Flowers appointed chairman of the sector’s ‘most ethical’ bank in 2010? Equally, how has it gone unchecked that board members at Co-op bank lacked business experience?


Reputation is one of the most prized and most vulnerable of corporate assets. Reputational damage caused by people is something the banking sector as a whole needs to address.  Errant human behaviour contributed to the banking crisis, and it appears that the Co-op succumbed to the same culture that allowed incompetent behaviour to go unchecked for years.


Urgent reforms are now needed at the Co-op Bank, but surely a priority must be to overhaul the recruitment process immediately and assess all current employees to ensure they are not just competent and behave in a way that adheres to the ethical standards and policies of the bank. Stamping out risky behaviour and introducing better ways of managing competence from the top down is vital. However, to deliver this kind of change, the bank needs to have a better understanding of the competence, knowledge and experience of its employees, as well as how they actually behave at work. Such insight will also enable the bank to uncover their specific training needs and also expose any risky behaviour and attitudes.


Ensuring people demonstrate the right behaviours consistently means investment, but organisations that get this right can reduce their risks. They are able to spot problems ahead of time and clamp down on risky behaviour and decision making. Assessments that examine employees’ behaviour and likely decision making should be part and parcel of working life – allowing managers to identify and address risky behaviour and deal with it ahead of time.


Assessing ‘People Risk’ needs to be part of the recruitment process and continuously monitored during employment, if it is to be truly effective. While, Co-op obviously made an error recruiting Paul Flowers, with adequate assessments in place for everyone, including the senior management team, his incompetence would have been uncovered sooner, averting a crisis.


To recover from this crisis, the Co-op bank clearly has a long road ahead but upholding its values is crucial and this can only be achieved if its people are competent and behave in the right way.

People Risk is an area that so far has received relatively little attention. Yet people represent the biggest cause of operational risk and the Co-op needs to know which employees are unlikely to follow the organisation’s procedures, practices and/or rules. They can mitigate ‘People Risk’ if they adopt a more holistic view to addressing it. They just need to ensure that their risk culture aligns their overall mindset and expectations with the individual competencies, attitudes and motivation of their employees.



Why are banks still espousing the ‘wrong kind of behaviours’?

The banking sector has faced unprecedented criticism over the past few years for failing to address the ‘rogue culture’ within banks that has led to a host of scandals from PPI mis-selling to Libor fixing; as well being partly responsible for the worse recession the world has ever seen.

Last month, Lloyds Bank has come under fire for its ‘unachievable’ front line staff targets that mean only a third of workers are hitting them and they are once again risking the ‘wrong kind of behaviours’ occurring.

According to the Lloyds TSB Group Union, who is due to report its concerns to the Financial Conduct Authority (FCA), employees who fail to meet targets can be placed on the bank’s Performance Improvement Process, which can result in them losing their job.

An anonymous Lloyds worker was quoted in the press as saying the pressure in branches is worse than ever and that reforms to the bank’s target schemes were ‘just a disguise’ to give the impression staff prioritise service above sales.

In a report last month the FCA said that all major high street banks have either replaced or made changes to high-pressure financial incentive schemes, which resulted in vast mis-selling of products such as PPI. It seems there are some banks, such as Lloyds that are not taking this seriously or are at best trying to give the impression they are adhering to reforms, when in actual fact not much has changed.

By operating high-pressure incentive schemes, banks are not simply encouraging healthy competition – the stalwart of the sales environment, they are encouraging the wrong kind of behaviour where greed takes over, and they risk making the same mistakes again that they have in the past.

Banks need to be encouraging a behaviour change to address excessive risk taking and bad decision making. They need to implement new ways to incentivise staff, as well as have measures in place that will uncover unwanted behaviours; before they become endemic to the work culture. Unachievable targets and the fear of losing their job is not the way to do this.

Do you think banking culture is changing? What are your experiences and do you feel that banks are starting to put customers first? How could staff be better incentivised? Please comment and share via your social media networks using the hashtag #bankingculture and #peoplerisk