In the face of increasing pressures, equality, diversity and inclusion offers NHS managers a pathway to foster supportive, inclusive environments that allow healthcare workers to thrive and patients to receive better care, writes Dr Melissa Carr.

An ageing population with complex needs. Long waiting lists and over-stretched services. Disengaged and demotivated staff. The recent Darzi report highlighted in grim detail the challenges facing the NHS.

With healthcare workers on the front line under huge pressure, it’s unsurprising to see high rates of burnout, stress and staff turnover.

With the Long Term Workforce Plan predicting a potential shortfall of between 260,000 and 360,000 NHS staff by 2036/37, retaining an engaged workforce is an organisational priority.

One crucial solution lies in the training and development of NHS managers who are equipped to lead teams within this challenging environment.

By using Equality, Diversity and Inclusion (EDI) practices, managers can create psychologically safe environments where team members can ask questions, raise concerns, admit mistakes and suggest improvements without fear of negative consequences.

How a culture of psychological safety can improve outcomes for staff and patients

Think back to a time when you worked in a team where finger-pointing and blame was the default. How would you have felt about reporting a mistake? Or suggesting a better way to do something?

Creating a safe workplace where colleagues can raise issues and share best practice is essential within any healthcare setting. As previous failings of care, and the inquiries that followed them show, toxic cultures can silence legitimate concerns.

EDI practices enhance and enable psychological safety in teams. The NHS equality, diversity and improvement plan highlights the importance of managers that can model inclusive leadership behaviours, guard against workplace bullying and discrimination, and create channels through which staff can speak up and highlight problems.

What research into psychological safety tells us about failure

More than 20 years of research has found that organisations with higher levels of psychological safety, often achieved through the implementation of EDI practices, consistently achieve better outcomes.

They don’t just protect staff from discrimination, stress and burnout. They can also have a transformative effect on how teams function.

Professor Amy Edmonson, who pioneered the idea of team psychological safety in the 1990s, discovered something interesting during her early research. Edmonson examined the relationship between error making and teamwork in hospitals but, rather than showing that more effective teams made fewer mistakes, the results found the opposite. Teams who reported better teamwork apparently experienced more errors.

A dive into the data explained why. It established that more effective teams reported more mistakes because they talked openly about them. It can feel challenging to hold your failures up to the light, but it’s the most effective way to troubleshoot systematic errors and drive positive change.

As a practical guide to improving patient safety culture published by the NHS in 2023 confirmed, team environments that allow for ‘intelligent failures’ which lead to reflection and improvement usually achieve the best patient safety outcomes. Psychological safety provides the environment in which this can work effectively.

As Amy Edmonson says: “Psychological safety is not about being nice. It’s about giving candid feedback, openly admitting mistakes, and learning from each other.”1

How integrated care systems can support safer workplaces

Within a culture of robust psychological safety and leaders trained in EDI processes, teams can openly challenge the status quo and flag fixable mistakes. Importantly, they are also empowered to suggest innovations that can improve the systems they work within.

One of the key functions of integrated care systems (ICSs) is to identify pockets of best practice across services and provide a platform where they can be widely shared. The repository of case studies on the NHS England website is a treasure trove of success stories – from social prescribing initiatives to fast-tracking cancer diagnoses by using AI.

ICS leaders must continue to create open channels for feedback. These help to foster team collaboration and trust, encouraging a no-blame culture, and shared aims and ambitions.

In a culture of collaboration rather than competition, this focus on knowledge-sharing encourages learning and improvement at all levels.

Using EDI practices to ensure psychological safety

Individual managers can make a big difference to their immediate teams but change on a larger scale can’t happen without clear organisational frameworks.

Equality, diversity and inclusion practices go hand in hand with psychologically safe workspaces. They provide the safety nets and support networks which allow people of all ages, ethnicities, sexualities and genders to share their lived experiences and raise concerns. They also work to erase the bullying and discrimination that makes workplaces fundamentally unsafe and silence the voices of staff.

In an organisation as multi-layered, complex and hierarchical as the NHS, inclusivity must be prized as highly as productivity. This means that everyone is given a platform to speak up, no matter their discipline, experience level or pay grade.

EDI frameworks aren’t a silver bullet for the complex issues facing the NHS. But they can tackle the significant problem of staff disengagement and enable a culture where diversity of thought is prized.

Empowering managers to lead teams

Psychologically safe workplace are as important to staff wellbeing as they are to patient safety. When employees feel valued, supported and – crucially – listened to, they experience lower levels of stress and burnout.

At Henley, we recognise that inspiring leaders can make a huge difference. That’s why we’ve partnered with NHS England to launch the first cohort for NHS colleagues pursuing careers in EDI.

Professionals at the beginning of their leadership journey, with no more than three years of experience within a management role, will learn the skills to create positive, inclusive and transparent working environments for their teams.