Owning what went wrong
Learning from failure, candour and ethical decisions.
Around four hours on owning what went wrong: learning from failure, building a learning system from complaints, candour and accountability, applied cases, and ethics and why good people do wrong things.
- Level
- Focus
- Learning time
- 4 hours 30 minutes
- Where
- Serving the public
- Price
- £69
When you step up to a higher level, what you paid in the last 12 months for lower-level courses inside the bigger course comes off its price, in proportion to how much of each is inside it, whichever topic it's from. Courses at the same or a lower level don't give credit against each other. A Focus course or above always costs at least £15. Read the full terms
Certificate of Completion, or Certificate of Completion and Assessment with a short assessment
Overview and Outcomes.
Who It's For
Senior leaders, complaints and governance leads, and board members in public services
Overview
How leaders respond when a public service fails decides whether trust is repaired or lost for a generation. Part of the Immerse When things go wrong, this Focus begins with Syed's black box thinking, Edmondson's three kinds of failure, Reason's Swiss cheese model and Dekker's just culture, then builds a learning system from complaints, including NHS England's Patient Safety Incident Response Framework. It explores candour through Hillsborough and the proposed Hillsborough Law, with the Public Services Ombudsman for Wales report on Trivallis, the Parliamentary and Health Service Ombudsman's state pension findings and the Post Office mediation scheme. It finishes on the Nolan Principles, hard ethical calls and Bandura's moral disengagement.
Aims
Put simply, the aim is to help leaders respond to failure with candour rather than defence: leading reviews that fix the system rather than blame individuals, turning complaints into learning, and reasoning through hard ethical calls with the clarity the public is entitled to expect.
In summary, you will be able to:
- Apply black box thinking, the Swiss cheese model and just culture to lead a review that fixes the system rather than blaming individuals.
- Plan a response that shows candour rather than defence, drawing on Hillsborough and the Post Office mediation scheme.
- Use the Nolan Principles and an understanding of moral disengagement to reason through a hard ethical call.
What you'll develop
Through this Focus course, you will build the ability to:
- Distinguish Edmondson's basic, complex and intelligent failures and choose a proportionate leadership response to each.
- Apply the four habits of useful learning reviews and the four aims of the Patient Safety Incident Response Framework to a complaint or incident in your own setting.
- Explain how delayed truth becomes a second injury, using the Hillsborough case and the Bishop James Jones report.
- Apply the five lenses to the Trivallis case to identify how repeat reports, records, vulnerability, complaint handling and governance contributed to harm.
- Explain each of the seven Nolan Principles and why the leadership principle asks more than personal good conduct.
- Apply the utilitarian, deontological and virtue lenses to the same decision and identify the tensions they reveal.
- Identify blind spots and moral disengagement mechanisms, such as ethical fading and diffusion of responsibility, in workplace decisions.
- Apply Reason's system approach and the restorative questions used at Mersey Care to shift the first question from who to what happened.
Built from 3 parts.
4 hours 30 minutes of learning.
- 01Failing well, learning fastLearning from failure and service improvementBitesize · Complaints, Ombudsmen and Learning from Failure2 modules
- 02Saying sorry and meaning itDuty of candour, apology and accountabilityBitesize · Complaints, Ombudsmen and Learning from Failure2 modules
- 03Why good people go wrongEthical decision making for leadersBitesize · Ethics, Integrity and Standards3 modules