Culture: Setting the culture on your ward

What is a positive culture?

As a Ward Manager, your role is key in creating a cohesive team that demonstrates a positive workplace environment. A positive ward culture is one where staff feel safe, valued, and clear about their role in delivering high-quality care. It is characterised by:

• Has a true understanding and appreciation of each team members strengths
• Has a clear understanding of their role and responsibilities
• Demonstrates openness and accountability
• Focuses on reflective practice and learning rather than blame

Why setting the culture matters?

These principles are not only a professional obligation but a core tenet of compassionate, person-centred healthcare Compassionate Leadership is endorsed as a values-based approach to creating high performing teams across Wales.

• Positive team cultures are associated with better patient outcomes, shorter hospital stays, improved patient experience and reduced staff sickness and turnover
• Incivility undermines safety and trust — 75% of patients who witness incivility report reduced trust in their care provider (Turner, Civility Saves Lives)

Setting the right culture is also a legal and professional responsibility:

• Duty of Quality : Under the Health and Social Care (Quality and Engagement) (Wales) Act 2020, NHS leaders and organisations must continually improve services by ensuring that care is is safe, timely, effective, efficient, person-centred (STEEP). Every leadership decision should support these principles, benefiting both staff and patients.
• Duty of Candour : Under the Health and Social Care (Quality and Engagement) (Wales) Act 2020, NHS leaders and organisations must be open and honest with service users when the care provided has, or may have, contributed to unexpected or unintended moderate or severe harm, or death. It strengthens the principles of Putting Things Right by ensuring patients and families are informed, supported, and involved when harm occurs
• People’s Experience (Wales) Framework : emphasises that experience is as important as outcome. Therefore, treating experience as core evidence, not just anecdotal when assessing service performance is a must. This includes triangulating data from compliments, complaints, PREMs, and staff reflections to inform holistic quality reviews.

How to set the culture on your ward

You and your team members can employ the following key strategies to meet the duties of quality and candour to create a positive culture:

• Model and encourage openness by routinely sharing real examples of safety challenges, lessons learned, and positive outcomes from speaking up during team discussions to normalise open dialogue. Create regular opportunities for these discussions to take place.
• Cultivate a just culture by consistently applying fair process that separates human error from risky or reckless behaviour and embeds restorative learning into incident handling.
• Provide education and training by delivering targeted sessions that teach psychological safety principles, human factors, structured communication tools like SBAR, and the legal and professional duties to speaking up.
• Promote psychological safety by creating regular opportunities, such as check‑ins, debriefs, and inclusive team norms that allow staff to safely express ideas, mistakes, and concerns without fear.

More resources about setting a positive culture

Speaking Up Safely - Raising concerns safely to improve care and culture

Website

Whistleblowing - Reporting wrongdoing or risks to protect others

Website

Raising concerns - Guidance for nurses, midwives and nursing associate

Website

Top tips for supporting the psychological safety of staff

Article 5 Minutes

Preventing burnout and wellbeing

Leading with compassion begins with caring for yourself. Ward Managers carry significant clinical, operational and leadership responsibilities, which can increase the risk of stress and burnout. While all team members should understand how stress develops and take responsibility for managing it, Ward Managers play an important role in modelling self‑compassion. Embedding wellbeing into daily practice creates a positive, resilient culture where managers and teams can thrive - supporting personal health, effective leadership, and the delivery of high‑quality patient care.

• Prioritise self‑care: Protecting your own wellbeing allows you to support others effectively. Maintain healthy habits, take protected breaks, set clear work–life boundaries, and seek support early. Use one‑to‑ones, supervision and PDRs to reflect on workload, discuss pressures, and explore ways to maintain balance.
• Build personal resilience: Strengthen resilience through reflective practice, problem‑solving, and structured support such as clinical supervision. Set realistic expectations, reframe challenges positively, and treat mistakes as learning opportunities. Celebrate individual and team achievements to boost confidence and motivation.
• Strengthen leadership support networks: Hold regular wellbeing conversations with senior nurses and use leadership support networks and peer groups to identify support needs, share experiences, and build collective resilience.

More resources about preventing burnout and promoting wellbeing

Make full use of your Health Board or Trust wellbeing offer, alongside with the following NHS Wales resources

NHS 111 Wales - Urgent mental health and wellbeing support

Website

Prevention and Management of Stress at work

Publication Long Read

Health and Wellbeing Hub - Resources, guides and support

Website

Mental Health and Wellbeing Strategy 2025-2035

Publication Long Read

People: Supporting and developing your team

Developing the team

Compassionate Leadership is key to building a high performing compassionate team. It encompasses building psychological safety, reiterating the need for all team members to feel valued and fulfilled in their roles.
This is a team effort, and below are some things for the whole team to participate in. Your job is to role model and create the opportunities.

• Lead by example: Demonstrate professionalism, integrity, and a commitment to continuous learning and improvement.
• Engage in reflective practice: Regularly reflect on leadership approaches, decision-making, and team dynamics to identify areas for personal and team development.
• Pursue ongoing professional development: Stay current with clinical, managerial, and leadership best practices through training, education, and networking opportunities.
• Encourage a culture of learning: Create an environment where staff feel supported to develop skills, take on new challenges, and engage in lifelong learning.
• Support career progression: Identify and nurture talent within the team, providing access to mentorship, training, and leadership opportunities.
• Facilitate regular supervision and appraisal : Use structured reviews to set goals, provide feedback, and support personal and professional development.
• Promote team cohesion and collaboration: Encourage open communication, mutual respect, and shared ownership of team goals.
• Recognise and celebrate achievements: Acknowledge individual and team successes to build morale and a positive working environment.
• Stay informed of national frameworks and policies: Align development initiatives with NHS Wales priorities, regulatory standards, and strategic goals.
• Evaluate impact: Regularly assess the effectiveness of development activities and adapt approaches to meet the evolving needs of the team and service.

A shared vision supports a positive culture, high performance, and consistent delivery of safe, compassionate, and person-centred care. Sign up for a 2-hour workshop

Managing performance effectively

There will be challenges to face that you are expected to manage. Effective people management is a key component of being a compassionate leader. How you lead and support your staff from the moment they join the team has a lasting impact, not only on their experience and job satisfaction, but also on the standard of care provided to patients.

Set clear expectations and goals

• Communicate ward and organisational standards clearly.
• Agree realistic, measurable goals with staff.
• Align ward activity to the National Outcomes Framework, focusing on wellbeing, safety, and fulfilment.

Provide regular feedback and development

• Maintain regular, informal performance conversations.
• Use structured reviews such as Value-Based Appraisal and regular 1:1s
• Support learning through CPD, mentorship, clinical teaching, and career development.

Recognise and reinforce good performance

• Acknowledge and celebrate achievements fairly and consistently
• Public recognition helps build trust, psychological safety, and a positive team culture.
• Use formal recognition schemes and awards where appropriate.
• Showcasing excellence clarifies expectations, normalises feedback, and supports retention and succession planning.

Address poor performance early and compassionately

• Monitor behaviour and practice and act on early warning signs.
• Hold timely, private, and respectful conversations to explore causes.
• Use organisational HR policies and escalate when needed.
• Create clear, supportive improvement plans with agreed actions and review points.
• Provide supervision, mentoring, reflective practice, and wellbeing support

More resources about managing performance effectively

People Performance Management Toolkit - Make time to talk about all aspects of performance

Website

Motivational Interviewing to enhance patient-centred care across Wales

Article 5 Minutes

Communicating clearly and consistently

Clear, effective communication is a core responsibility of the ward manager and underpins safe care, staff confidence, and trust with patients and families.

• Ensure timely, effective transparent communication within the ward for staff, senior managers, patients, and families.
• Establish and maintain structured two-way communication channels such as safety huddles, team briefings, handovers, noticeboards, and agreed escalation routes.
• Raise concerns and performance issues through appropriate governance structures and provide clear feedback to the team on outcomes and learning.
• Communicate clearly with patients and families with accessible, straightforward information about care, safety, infection prevention, and any changes affecting their experience.
• Model open and visible leadership through active listening, approachability, and openness to foster a culture where communication supports patient safety, staff wellbeing, informed decision-making, and continuous improvement.

Consult our practical scenarioswith clear, consolidated top tips to understand how to apply effective communication.

Hosting a meeting

Dealing with acute clinical situation

Managing a difficult conversation

Writing reports

Clinical Quality Management

Ward Manager’s role: Monitor and improve quality and safety using data and performance information.

How it can be applied: As part of a Quality Management System (QMS), use data to monitor, control, and improve the ward’s performance, covering audits, incident reporting, and compliance with NICE and safety standards.

Hosting a meeting (online or in-person)

Focus: Strong agenda control, punctuality, capturing all viewpoints, action-logging, and standardised communication.

• Circulate a fixed agenda in advance, allocating time to each item.
• Begin and end meetings on time.
• Use structured turn-taking (e.g., clockwise or “raise hand”function online) to ensure all voices are heard.
• Record decisions and actions live in a shared document visible to attendees.
• Finish with a concise action recap: who is responsible, deadlines, and how updates will be tracked.

Dealing with acute clinical situation (e.g., deteriorating patient or resuscitation)

Focus Monitor and improve quality and safety using data and performance information.

How it can be applied: As part of a Quality Management System (QMS), use data to monitor, control, and improve the ward’s performance, covering audits, incident reporting, and compliance with NICE and safety standards. Use clear, concise, and standardised communication frameworks, define roles, and ensure rapid information flow.

• Use closed-loop communication (e.g., “Give 1 mg adrenaline” → “1 mg adrenaline given”).
• Apply structured tools such as SBAR to reduce ambiguity. (SBAR: Situation, Background, Assessment, Recommendation – provides framework for handing over information)
• Appoint a ‘communication lead’ to coordinate updates and repeat critical information.
• Minimise noise and interruptions; only essential personnel should be present.
• After the event, provide brief, factual updates to staff and families, avoiding jargon and Debrief with Team.

Managing a difficult conversation (incident investigations or delivering bad news)

Focus: Structure, clarity, compassion, and evidence-based dialogue.

• Prepare a concise, factual summary and clarify the meeting’s purpose and required outcomes.
• Choose a private setting, state the purpose at the outset, and deliver messages directly and without jargon.
• Allow the individual time to speak without interruption and check understanding with follow-up questions.
• Document agreed actions and responsibilities during the meeting, confirming next steps in writing.
• Provide supportive resources and follow-up contact details as needed.

Report Writing

Focus: Factual, chronological, timely.

• Use a template: Where possible use your organisation’s approved template to ensure consistency and compliance. e.g. SBAR, RCA
• Stick to the facts: Record exact times, actions, observations, and who was involved without opinions or assumptions.
• Be clear and concise: Use short sentences, bullet points, and standard terminology; avoid vague or emotional language.
• Document escalation: State who you informed, when, and what response you received.
• Check accuracy quickly: Verify details against notes, charts, and digital records before submitting.
• Attach evidence: Add observations, readings, or relevant documentation where required.
• Submit: Complete and file the report as soon as possible to maintain accuracy.

Dealing with conflict and concern

Conflict can arise in high-pressure healthcare environments, even where a positive culture exists. When dealing with conflict, leading with compassion:

• Protects staff wellbeing, morale, and patient safety
• Ensures fair and consistent management of concerns
• Builds trust and psychological safety
• Supports learning and continuous improvement

To deal with conflict that supports a positive team culture:

• Create safety and encourage early reporting: Foster an open environment where concerns can be raised without fear. Use regular check-ins and wellbeing conversations to identify issues early and prevent escalation.
• Acknowledge, listen, and gather information: Act promptly when concerns arise. Listen actively and without bias, show empathy, and gather relevant information so all voices are heard and the full context is understood.
• Clarify expectations and address issues early: Reinforce roles, values, and professional standards through informal 1:1 conversations. Provide honest, structured feedback and clearly set expectations around behaviour, performance, and accountability.
• Apply policy fairly and support resolution: Use the All-Wales Respect and Resolution process and organisational policies consistently. Consider mediation or HR support when appropriate, apply Just Culture principles, and ensure decisions are fair, proportionate, and well documented.
• Support learning, recovery, and team culture: Agree clear actions and review points, offer coaching, mentoring, or wellbeing support, and reflect on root causes, debriefing approach when appropriate. Share learning where appropriate, address disruptive behaviour swiftly, and promote dignity, respect, and continuous improvement.

More resources about dealing with conflict and concern

Healthy Working Relationships

Website

Managing difficult behaviour

Playlist Long Read

Compassionately Managing Conflict

PlaylistLong Read

How to Lead a Conversation Between People Who Disagree

Video9 mins

When Rudeness in Teams Turns Deadly

Video15 mins

Systems: Building and sustaining your workforce

Creating and maintaining a safe ward environment

Along with your workforce, the physical environment also needs to be managed. Some environmental considerations are:

1. Safe, Clean and Well‑Maintained Environment

• Maintain a clean, safe ward that meets environmental cleanliness and IP&C standards.
• Complete daily/weekly/monthly checks and act promptly on issues.
• Lead compliance with infection prevention practices and promote safe behaviours.
• Ensure environmental risk assessments are completed, updated andacted upon.

2. Equipment & Resource Management

• Ensure all equipment is available, safe, functional and serviced.
• Maintain stock levels for clinical supplies, PPE and essential consumables.
• Promote safe and appropriate use of equipment and escalate faults quickly.
• Oversee access to IT systems, digital tools and resolution of technical issues.

3. Compliance With Standards & Regulation

• Ensure adherence to Health & Safety legislation, IP&C guidance and dress code requirements, be aware of Digital screen environment.
• Complete and act upon audits (cleaning, hand hygiene medicines, equipment, environment).
• Uphold dignity, respect and organisational values in all practice.

4. Emergency Preparedness

• Ensure emergency equipment (resus trolley, oxygen, suction) is present, checked and ready.
• Ensure staff know fire, evacuation, security and emergency response processes.

5. Major Incident

• Be aware that a major incident is an event that overwhelms normal NHS Wales services and triggers a coordinated organisational response. It may require ward managers to activate ward‑level emergency procedures that could include staff relocation, managing bed capacity, communicate with the command structure, ensure patient safety, and support the hospital’s operational response.

6. Visitors

• Be responsible for ensuring that all visitors, contractors, and non‑ward staff on the ward follow safety procedures, infection prevention measures, sign‑in requirements, and local policies, maintaining a safe, controlled environment for patients and staff.

Leading budget management

Most ward managers manage their wards allocated budget. Managing the budget is more than just monitoring its expenditure. To understand your budget you need to:

• Get support: Organise a session with your finance representative (accountant)
• Know your budget allocation:Budgets vary by unit and are influenced by factors such as patient acuity and staffing levels. Your specific allocation is shown in your monthly budget report.
• Understand the two budget elements: Around 70% of the budget is for staff pay, with the remaining 30% covering non-pay costs such as pharmacy, medical supplies, stationery, and services like translation.
• Manage pay through accurate rostering: Check that the monthly pay report reflects the workforce data entered and validated in HealthRoster. Effective “Pay” management stems from organised roster management.
• Keep ESR data up to date: Ensure ESR accurately reflects who worked during the previous month. Flag changes to your workforce representative, including leavers, starters, role or band changes, and retirements.
• Oversee non-pay spend as a team: You are accountable for monitoring and justifying non-pay expenditure, ensuring costs are charged to the correct cost centre and orders match deliveries. Stock ordering and monitoring can be delegated to team members.
• Control stock and ordering: Regularly review usage and stock levels, use standard order catalogues, and make sure the ordering process is clear and consistent.
• Plan ahead financially: Engage in business planning to anticipate future costs, identify efficiencies, and secure resources that align with service and organisational priorities.

Maximising workforce potential

Headrooom means 26.9% additional staffing hoursare added on top of your ward’s core staffing requirement.

This allowance helps you to:

• Cover annual leave, sickness, and other predictable absences
• Release staff for training, supervision, and development
• Maintain safe staffing without over-reliance on agency staff
• Support staff wellbeing, resilience, and continuity of care

Your finance representative can support you in understanding how headroom is reflected in your workforce data and budget reports.

Workforce Planning

Once you have the correct establishment for your ward, you need to take ongoing action to maintain a safe and sustainable workforce. This is known as workforce planning.

As a ward manager, you will routinely plan across four key areas:

• Recruitment – attracting and appointing new staff
• Retention – keeping skilled and experienced staff
• Retirement – planning for staff leaving at the end of their careers
• Succession Planning – preparing people to step into future roles

To be effective at workforce planning, you need to understand your current service requirements and your future service demands, looking at least 12 months ahead.

This includes:

• Monitoring and forecasting staffing levels
• Reviewing skill mix and capability
• Understanding turnover and vacancies
• Planning for retirements, maternity leave, and changes in contracted hours
• Identifying internal workforce trends

Workforce planning is strengthened by horizon scanning, which looks beyond immediate pressures and considers longer-term influences on your workforce.

Horizon Scanning may include:

• Changing population health needs
• Recruitment challenges or opportunities
• Service redesign
• Digital transformation
• Policy and system changes

More resources about workforce planning

Workforce Planning Hub - Guidance and Training

Website

Strategic Nursing Workforce Plan 2025-2030

Publication Long Read

Recruiting Managers Pack

Website

NHS Pensions

Website

NHS Pensions Scheme

Website

Succession Planning and Talent Management - Guidance and tools

Website

Student Streamlining Scheme

Website

Delegating Safety

You must ensure delegation and task allocation are safe, structured, and aligned with policy. Delegation requires matching tasks to staff competence, providing clear instructions, and maintaining appropriate oversight.
Staff must work within their scope of practice, supported by up‑to‑date competency assessments and clear escalation routes.

Accountability is shared:

• Ward managers ensure safe systems and appropriate skill mix.
• Registered nurses remain accountable for the decision to delegate.
• The person undertaking the task is accountable for performing it safely and recognising their own limitations.

Competence must be regularly reviewed, documented, and supported through training, supervision, and feedback. Effective delegation strengthens team capability, improves workflow, and enhances patient safety.

When delegating:

• Always match the task to competence , not availability
• Give clear, unambiguous instructions and check understanding
• Follow delegation with oversight and review outcomes
• Promote psychological safety so staff can decline tasks beyond their competence
• Use delegation to support development through structured learning opportunites

Read the All Wales Delegation Guidelines for further information.

Change: Leading through change

Leading organisational change effectively

An Organisational Change Policy (OCP) is the formal framework used across NHS Wales to manage internal change safely and consistently.

It applies to changes such as:

• Service reviews
• Restructures
• Mergers or de-mergers

The policy ensures that change is planned, fair, transparent, and focused on protecting staff and maintaining safe services.

Who Leads and Manages Organisational Change?

The People (HR) Team leads the organisational change process. They are responsible for:

• Setting the principles and processes for change
• Ensuring legal and policy requirements are followed
• Protecting staff rights and supporting fair consultation

The Role of Ward Managers

Ward Managers play a critical role during organisational change by acting as the link between HR, senior leaders, and frontline teams. Their role includes:

• Communicating clearly why change is happening
• Helping staff understand how they may be affected
• Listening to concerns and escalating them appropriately
• Supporting staff wellbeing during periods of uncertainty
• Maintaining service quality and patient safety
• Signposting staff to support, training, and development opportunities

The Organisational Change Process

Organisational change follows a structured and transparent process:

1. Identify the need for change – Clearly define why change is required and what the organisation aims to achieve.
2. Early engagement and planning – Involve key stakeholders early to shape the proposal and establish a structured plan.
3. Formal consultation – Share the proposal with staff and unions, gather feedback, and consider amendments.
4. Decision and implementation – Confirm the final model, communicate outcomes, and put the agreed changes into action.
5. Evaluation and review – Assess whether the change met its objectives and identify lessons for future improvements