Anchoring a just and compassionate culture in NHS disciplinary processes

The practice of disciplinary processes in the English NHS has changed little, despite the introduction of a ‘just culture’ approach a decade ago. This article brings together a narrative review of relevant literature with the authors’ experiences as a therapist for NHS Practitioner Health (a specialist service that provides support for NHS staff) and a clinician with lived experience of a disciplinary procedure, who has since become a peer mentor. The literature indicates that harsh disciplinary processes are often the expression of poor organisational culture, which not only harms staff and the organisation itself, but is also closely linked to reduced patient safety. Culture change is complex and cannot be ‘implemented’, but must grow organically from the bottom up. The authors describe, from their own experience, how an individual investigator can reflect on and change their attitudes and behaviours towards becoming more fair, compassionate and kind. The barriers and enablers of culture change at an organisational level are also discussed, and suggestions are made as to how organisations could foster change towards a just culture.