Workplace conditions

This Element examines the workplace conditions that underpin successful improvement of quality and safety in healthcare. It highlights aspects of the workforce and working environment that may thwart or support healthcare improvement in practice, while recognising that good workplace conditions can also be outcomes of healthcare improvement. We examine the role of three key workplace conditions that are prerequisites for the work of improving quality and safety in healthcare: staffing for quality; psychological safety, teamwork and speaking up; and staff health and well-being at work. We summarise the evidence and show how each contributes to organisational capacity to deliver quality and safety and enable improvement, and explain how success can be assessed. There may be little dispute about some of the preconditions (funding, staffing, training) for improving quality and safety. But many of the issues we present in this Element operate at multiple levels and vary within and between organisations and workplace units, since staff experiences are shaped by their immediate teams as well as the whole organisational context and culture. Accordingly, much of our analysis is based on the principle that, fundamentally, healthcare work is interactional. People’s actions, interactions, and relationships with each other are critical to enabling an organisation to adopt, implement, and sustain improvements.