However, it was also striking to me that for the first few minutes of our talk on \u2018just culture\u2019 that my thoughts did not immediately connect with the incredibly important issues which Professor Sir Norman Williams published. It was a phrase I had seen and heard before but had wrongly assumed, based on my experience and without questioning, that it referred to another \u2018just\u2019 culture. This \u2018just\u2019 culture, however, was a version which existed in my head – the one I have sadly experienced at various points during my entire career in the NHS in numerous locations. Given how often I had heard the term \u2018just\u2019 being used in the NHS, I had wrongly assumed this is what everyone was always referring to when they spoke about a \u2018just culture\u2019 and that\u2019s why people wanted to do something about it. The one I had in my head however was something altogether different to that of Professor Sir Norman Williams. Mine was the unseen or other \u2018just\u2019 culture \u2013 one of exceptionalism which refers to the culture of using \u2018just\u2019 as a prefix, often in a negative and derogatory fashion to justify treating someone differently or used to justify an action.<\/p>\n
The \u2018just\u2019 prefix is sadly used far too often in healthcare and speaks of the culture which exists in the NHS. It is commonly used in all lines of healthcare and used liberally for tasks, behaviour and people. Whilst for tasks, this might be justified \u2013 \u2018can you just insert a cannula for me\u2019, it becomes a significant and damaging problem when it is used to dismiss or diminish unacceptable behaviour or used to describe and demean people and roles. For unacceptable or discriminatory behaviour, \u2018Just banter\u2019 is used an excuse to diminish and \u2018play down\u2019. \u2018Just a joke\u2019 or \u2018I was just\u2019 is heard too often and this hidden \u2018just culture\u2019 feeds into the prevailing culture of NHS organisations and what staff on the ground, and in turn what their patients experience on a daily basis. Often these incidents or behaviours can be sadly dismissed as \u2018woke concerns\u2019<\/p>\n
Describing people or roles is equally as damaging – whether it be used to justify asking someone to do something deemed beneath the person asking it or denying them opportunities such as teaching based on their role or status e.g. \u2018just a staff grade\u2019 or \u2018just a junior doctor\u2019, these phrases have crept into the NHS lexicon far too often over many years. Often people have had bad experiences themselves in their own training and think this justifies behaving in the same way as it\u2019s \u2018just a junior doctor\u2019 and therefore it doesn\u2019t matter. That\u2019s nothing to say of the use of \u2018just\u2019 to speak about our valuable nursing, AHP and management colleagues as well as the other thousands of non-clinical support staff \u2013 cleaners, porters and others all working within the NHS.<\/p>\n
The BMA have recently changed the terminology for what have traditionally been called \u2018junior doctors\u2019 or doctors in training. These doctors are now referred to as \u2018resident doctors\u2019<\/a>. Whilst the reasons for this are many \u2013 to reflect the experience and skillset of these important group of doctors which makes up nearly 25% of all doctors in the UK and to mirror the terminology in the US and Spain to name but a few, part of this will be no doubt to change the narrative from both employers and the public as to how these doctors are perceived. They are not \u2018just junior doctors\u2019 \u2013 they are the future of the NHS, often with many years of experience in the latter years of their postgraduate training. Renaming or not, treating them as \u2018just a resident\u2019 does a disservice to the NHS and the various national workforce policies which exist \u2013 without basic respect and recognition, the rebranding is meaningless<\/p>\n
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