But I feel the most important thing is ward culture. On a ward with a good culture, the occasional person who can't help themselves when it comes to bad practice is dealt with.
I eked out my student loan by working as a cleaner in a small (4 ward) geriatric hospital and was very struck by how much ward culture permeated into every aspect of life and work on the wards. Three of the wards were lovely, homelike places, where patients were treated with enormous kindness and good humour. The fourth was identical in every way, same lay out, same staffing levels, same ratio of bedridden to ambulatory patients, same food, same cleaning staff, yet it was a miserable place.
Confused old people lay in their beds moaning and begging for help, it was like something out of Dante's inferno. At first I kept trying to winkle a member of staff out of the fug of smoke in their breakroom to come and find out what was wrong, but they said that the patient just enjoyed making those noises, it wasn't worth bothering with them because nothing was ever good enough, that the situation was being monitored and that input from the cleaning staff on the subject of patient care was not required.
Now that I am 40 years older and have a load more experience I strongly suspect that those poor old people were in constant pain due to bed sores, because they were being turned less often than the bed ridden patients in the other three wards, and probably also that incipient sores weren't being caught and prevented from getting worse. At the time I was too inexperienced and ignorant to have a clue what to do with my concerns, so I'd get through my work as quickly as possible so that I could escape to the next ward.
I think that hospital should have been secretly filmed for a documentary to find out what was causing that one ward to be so horrible when the other three were lovely, and the footage used as a teaching example when training ward managers and health care staff.