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September 5, 2018

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HCAT

Using the Hudson Ladder in the context of health culture

Is the Hudson Framework suitable for health culture? David Day, Head of SHE at nuclear specialist Nuvia UK, talks about why he has selected a particular cultural model as the basis to develop a health culture assessment tool.

As part of a study into developing a health culture assessment tool (HCAT), I needed to find suitable theoretical model on which to base my HCAT. This got me thinking – could I use the Hudson Ladder (reference 1)?

The Hudson Ladder (see figure 1) is described by Hudson (reference 2) as an evolutionary ladder, which plots the development of an organisation’s safety culture. Each level has distinct characteristics and is a progression from the previous level. The range runs from the pathological, through to the reactive, to the calculative, on to the proactive and then the final stage of generative.

Figure 1: The Hudson Ladder

Hudson Ladder

Hudson further defines each level of culture as follows:

  • Pathological safety culture: Safety is a problem caused by the workers. The drivers are the business and a desire not to get caught by the regulator;
  • Reactive safety culture: Organisations start to take safety seriously, but action is taken only after incidents;
  • Calculative safety culture: Safety is driven by management systems, with much collection of data. Safety is still primarily driven by the management and imposed rather than looked for by the workforce;
  • Proactive safety culture: With improved performance, the unexpected is a challenge. Workforce involvement starts to move the initiative away from a purely top down approach;
  • Generative safety culture: There is active participation at all levels. Safety is perceived to be an inherent part of the business. Organisations are characterised by chronic unease as a counter to complacency.

What makes the Hudson Ladder suitable for health culture?

Measurement of the tangible and intangible aspects of health culture

The tangible and the intangible aspects of health culture are built into the Hudson Ladder. In terms of tangible aspects, each culture level description features a reference to either structures, systems, practices, controls, or policies regarding the management of risks. For example, the calculative level description features a reference to risk management systems. In terms of intangible aspects, the Ladder features descriptions of beliefs, attitudes, or values regarding the pursuit of occupational health in the form of trust, accountability, and degree of ‘informedness’.

Use of the Ladder in the context of health culture

The Hudson Ladder has proved to be a success in the context of health culture. For example, Tappin et al. (2015) (reference 3) used the Ladder as the foundation to develop the Musculoskeletal Disorder Culture Assessment Tool (MSDCAT). This study reported the MSDCAT to be an effective tool for identifying an organisation’s musculoskeletal cultural maturity across a range of industries. Furthermore, in the future, the Ladder’s validity will be further boosted when Tappin and colleagues apply the Ladder in the context of psychosocial health.

Use of the Ladder in the development of culture assessment tools

The Ladder has proved to be an effective foundation for the development of safety and health culture assessment tools (see Table 1). This effectiveness is illustrated by Parker et al. (2006) (reference 4) who used the Ladder in semi-structured interviews in an oil and gas organisation, the transcripts from which were then analysed leading to the development of an organisational safety culture Ladder. This Ladder is now used across the world by multi-national organisations. For example, it forms the core component of Shell’s health and safety culture improvement programme called the Hearts and Minds Programme.

 Table 1: Use of the Hudson Ladder in the development of culture assessment tools

Hudson Ladder

The use of the Ladder in a high-risk industry

The host organisation is a high-risk industry nuclear engineering and waste management company. Table 1 shows that the Hudson Ladder has been used in a range of high-risk industries. For example, Kirk et al. (2007) (reference 7) used the Ladder to develop the Manchester Patient Safety Assessment Ladder in the context of healthcare. Moreover, Filho et al. (2010) (reference 8) used the Ladder to develop a safety culture assessment tool in the Brazilian petrochemical industry. Therefore, the Ladder is highly suited to a high-risk industry.

User-friendliness and pictorial nature of the Ladder

The literature suggests that the Hudson Ladder is easy to grasp as it provides users with a visual understanding of where their culture is and what a more advanced health and safety culture might look like (Hudson, 2007) (reference 1). This user-friendliness is demonstrated in Ashcroft et al. (2005) (reference 5), who reported that the study participants easily understood the Hudson Ladder and the key differences between the five levels of culture maturity.

Use of the Ladder across hierarchy

The Hudson Ladder has been proved effective with all hierarchical levels of an organisation. For example, Kirk et al. (2007) (reference 7) used the Hudson Ladder in the health care sector with multi-professions, for example, with pharmacists and nurses, across a range of different hierarchical levels.

Conclusion

The Hudson Ladder is suitable to its success in the context of health culture, its ability to measure both the tangible and the intangible aspects of health culture, its effectiveness in the development of culture assessment tools, its use in high risk industries, its user-friendliness and visual composition, and its suitability to be used across hierarchical level. All in all, a good basis on which to develop a new health culture assessment tool.

References

Reference 1 – Hudson, P.T.W. (2007). Implementing a safety culture in a major multi-national. Safety Science, 45, 697–722.
Reference 2 – Shell International BV (2007). Safety Culture Ladder video. Available at: http://www.eimicrosites.org/heartsandminds/userfiles/file/UYC/UYC%20Animation%20 %20Safety%20culture%20ladder%20English.swf.
Reference 3 – Tappin, D.C., T.A. Bentley, T.A. & L.E. Ashby, L.E. (2015). An implementation evaluation of a qualitative culture assessment tool. Applied Ergonomics, 47, 84-92.
Reference 4 – Parker, D., Lawrie, M. & Hudson, P. (2006). A Ladder for understanding the development of organisational safety culture. Safety Science, 44, 555-562.
Reference 5 – Ashcroft, D.M., Morecroft, C., Parker, D. & P R Noyce, P.R. (2005). Safety culture assessment in community pharmacy: development, face validity, and feasibility of the Manchester Patient Safety Assessment Ladder. Quality and Safety in Health Care, 14, 417-421.
Reference 6 – Lawrie, M., Parker, D. & Hudson, P. (2006). Investigating employee perceptions of safety culture maturity. Safety Science, 44, 259-276.
Reference 7 – Kirk, S., Parker, D., Claridge, T., Esmail, A. & Marshall M. (2007). Patient safety culture in primary care: developing a theoretical Ladder for practical use. Quality and Safety in Health Care, 16, 313-320.
Reference 8 – Filho, A.P.G., Andrade, J.C.S. & de Oliveira Marinho, M.M. (2010). A safety culture maturity model for petrochemical companies in Brazil. Safety Science, 48, 615-624.

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Matthew Lawrie
Matthew Lawrie

The safety culture ladder does indeed transfer well across organisations and industries. Each time we use it we learn about how it applies to so many aspects of what organisations do. Best wishes with your HCAT project.