National Trauma Transformation Programme: Trauma-Informed Substance Use Pathfinders – Learning Report

Organisational Culture

Culture represents an organisation’s fundamental approach to its work. It reflects what is considered important and unimportant, what warrants attention, how it understands the people it serves and the people who support them, and how it puts this understanding into daily practice. In short, culture expresses core values.

Culture extends well beyond the introduction of new services or the training of a particular group of staff members; it is pervasive, and includes all aspects of an organisation’s functioning. Leaders within organisations have a key role to play in setting and maintaining a positive and supportive culture and values.

Challenges in the Pathfinder areas

The COVID pandemic and associated working practices placed a tremendous pressure on NHS staff and service leads who continued to offer services as best they could despite increased levels of staff sickness and absence. Viewing this through a trauma-informed lens, there was evidence that both pathfinder areas were working more reactively, with staff and management feeding back feeling that they were constantly ‘fighting fires’ and only able to deal with immediate challenges and problems (this means they were operating in the ‘red zone’ of their organisational Window of Tolerance)^[8]. This context had an overall impact on trauma-informed organisational culture as it affected relationships within teams, with management, as well as on relationships between staff and the people they support. In both pathfinder services, staff would have benefited from more opportunities to articulate concerns they had about service design, structure, and operation.

Staff health and wellbeing in the pathfinders was an area for concern as a result of the system and staffing pressures, amplified by COVID and the loss of experienced staff. This was evidenced by the high levels of sickness and attrition and was made particularly difficult in the context of a high number of local drugs-related deaths.

Staff in the pathfinder areas faced challenges in their capacity to free up time to undertake training to support them to understand the prevalence and impact of trauma on staff and people coming into contact with the organisation. This impacted on their confidence in how to apply a trauma-lens to their practice and the associated language used when communicating with each other and with people they support.

Enablers in the Pathfinder areas

Positive culture change was apparent in one site in particular, due to multiple factors, including staffing levels becoming more adequate over the course of the pathfinder period which reduced pressure on staff and management. Other factors included the production of a dedicated implementation plan which focussed on staff wellbeing, trauma training and trauma-informed coaching for the service lead.

Working practices were changing to focus more on staff wellbeing, relationships between staff were improving and staff reported thinking more about what had happened to clients and the impact these experiences had on them, rather than what was ‘wrong’ with them. In one area, staff were also more empowered through involvement with the TI lens event, the set up and progress made by the TIPIG and the actions on the implementation plan with some evidence they were feeling more confident to suggest and make changes.

Pathfinder Recommendations relating to Trauma-Informed Culture

• Each organisation’s culture will look and feel different, but it is important to consider how trauma-informed principles, values and ways of working are embedded in an organisation.
• Completing an organisational assessment tool and service-specific lens walkthrough can support teams/ services organisations to reflect on strengths, challenges and opportunities across strategic and operational aspects.
• If substance use services are exploring opportunities for embedding a trauma-informed approach, it is important that they assess their readiness for starting this work. A dedicated implementation plan which includes a focus on staff wellbeing has been found to enable positive culture change.