There are many definitions of culture, including the ‘customs, attitudes and social behaviours of a particular group, or society’, but more commonly organisations describe their culture in terms of values and behaviours. In health and social care it was once presumed to be implicit that care and compassion were the bedrock of the professionals caring for us. The belief was that staff would do what was right.

This presumption has been challenged in so many ways because of scandals that have shaken our trust in those who should care for us when we are at our most vulnerable. The failures at Mid Staffordshire Foundation NHS Trust and the abuse of those at Winterbourne View Hospital will stay with professionals and the public for a long time to come.

In both these organisations the culture at the time was to tolerate poor care and when staff or families attempted to question practices they were silenced or shunned. Staff report working in an atmosphere of fear because of potential reprisals.

So, what is a culture of candour?

Candour is often described as being open and honest, or being truthful and frank, so a culture of candour is one where the expectation is that staff, or patients and their families, feel safe to highlight care that is sub-optimal and that it will be addressed appropriately and lessons learnt. This works best when the patient is the centre of the organisation and poorly when targets alone are its focus.

A culture of candour is not just a matter of fulfilling a statutory (legal) requirement (Duty of Candour) but supports the provision of safe, effective and sensitive care. It promotes an environment where patient safety is paramount and where there is a system of learning and continuous improvement. To facilitate a safer environment staff should be equipped with the skills and knowledge, through training and support, to:

  • identify risk and the potential for things to go wrong
  • report situations that concern them in the knowledge that they will be listened to
  • be actively involved in finding solutions and reducing risk

However, despite systems and processes designed to mitigate risk, healthcare has many uncertainties and harm cannot be fully eliminated. A culture of candour supports the recognition that to improve patient safety, staff need to feel safe in the knowledge that by being open and honest they will not be unfairly blamed. Human error can initially appear to be the cause of a safety incident, but it is well recognised that human error is more likely to occur in unsafe systems. So, understanding the system in which the error occurred is the most effective way of finding a solution and minimising the risk of a similar incident.

When harm occurs clinical staff need to feel confident to communicate honestly, sensitively and effectively with patients, families or carers. Although published in 2009 ‘Being Open’ remains to this day a comprehensive framework that sets out the principles of effective communication including:

  • acknowledgement
  • truthfulness, timeliness and clarity of communication
  • apology
  • recognising patient and carer expectation
  • professional support

For a culture of candour to pervade staff require training and support as well as a commitment from board and senior managers within the organisation. Ultimately, a culture of candour has the potential to significantly improve patient safety, improve communication and build a more trustful relationship between patients and those caring for them. The Duty of Candour legislation is a powerful tool to support this.



This is the second in a three-part weekly blog series by Elaine Spencer on the topic of Duty of Candour and the requirement for openness in the NHS. Subscribe for future blog posts by entering your email address above.

Relias released its Duty of Candour e-learning course on 1st February 2018. To experience the course, and discover how it can help your healthcare staff, simply fill out the form below.