This is part two of a three part series of articles by Steve Turner. For Part One please click here
In light of the recent announcement by the Secretary of State for Health in England of a review of whistleblowing, and new initiatives announced to improve patient safety.I’ve been working on a list of steps which will help deliver safer care. The aim is to bring together various influences and focus on the key messages. The main influences are the King’s Fund work on developing collective leadership; the announcement by the Secretary of State for Health on a review of whistleblowing in the NHS; the NHS England ‘Sign up to Safety’ campaign and the increased focus on human factors in healthcare.
There is really nothing new in what I have to say. It’s all based on the work of others. What I’ve tried to do is draw together the key themes, initiatives, reports and recommendations. Actions on all these are all needed in equal measure to deliver safer, cost-effective, healthcare.
2. Listen to concerns (and learn from mistakes)
There is a huge body of evidence that many healthcare organisations don’t listen to concerns, and develop a culture where people are afraid to raise concerns. It’s not just the recent events at Mid Staffordshire and Winterbourne View. The writing has been on the wall for years. If you want to know more (or use examples to learn from) have a look at these reports:
- Maidstone and Tunbridge Wells clostridium outbreak A picture of avoidable loss of life partly due to a ‘disconnected’ board, which happened in 2005/6
- The Airedale Enquiry A shocking story of individual, governance and systems failings which happened between 2000 and 2002
These healthcare failings did result in improvements and significant changes but, I would argue that in England in particular, until recently, the underlying culture worked against moves to improve safety.
There is still a big gap in perception when it comes to culture. In a survey conducted by the King’s Fund published in 2014 over 80% of Executives strongly agreed that their organisation was ‘characterised by openness, honesty and challenge’, compared with less than 40% in each of the managers, doctor and nurses categories. Secrecy; fear and a failure to listen feature in many of the recent reports on the culture of healthcare organisations, contributing to Don Berwick’s comment ‘Fear is toxic to both safety and improvement’.
Staff at all levels, but particularly leaders, not being respectful to each other is a key feature of the Kings Fund’s work on collective leadership (see Michael West’s blog for more on this). In my view, having worked at all levels across many organisations, the negative effect of this wilful disrespect is underreported by commentators:
|‘If there are strong values of compassion and safety, new staff learn the importance of caring and safe practice. If they observe senior staff behaving aggressively or brusquely, they assimilate that. In short, if we want to improve care, we must focus on nurturing appropriate cultures’.|
Recently this need to listen to concerns has taken a huge step forward with the instigation of a review of whistleblowing in the NHS. This to be by Sir Robert Francis Q.C., the man who conducted the Mid Staffordshire review. Those who have silenced people who have spoken out, and acted without integrity and transparency; acted disrespectfully to colleagues and failed to listen may well feel very uncomfortable with this decision to review.
I am very pleased that this step forward has been taken. This, together with the NHS England ‘Sign up to safety’ campaign and strong support from NHS Employers for increased openness hopefully signals a new era in healthcare culture in England and beyond.
Unfortunately, having read up on English whistleblowers’ cases, and met some of those involved, I believe there are more shocking revelations to come.
So how do we learn from mistakes? Don Berwick (you can see I’m a fan!), in The Berwick Review noted:
My key ideas for action here are (for healthcare organisations):
- (Develop), implement and review a strategy for ‘collective leadership’
- (Develop) implement and review a strategy for learning from mistakes
- Sign up to the NHS England ‘Sign up to Safety’ Campaign now
- Sign up to the Nursing Times ‘Speak out Safely’ Campaign now, and any other initiatives which send the right message to staff, patients and the public
- Be nice to each other! Do not tolerate incivility by anyone to anyone. This doesn’t mean being ‘soft’. Be clear with those who do not act accountability, whatever their position.
- Protect and support those who raise concerns. Complaints and concerns are ‘gold dust’.
‘Steve has a background in healthcare delivery and information technology as Head of I.T. in an NHS Trust, and worked as a senior healthcare consultant for a US company. Steve is a registered general and mental health nurse prescriber, having worked in an assertive outreach team. He has an honours degree in social policy and post graduate diploma in clinical education. Steve now leads Care Right Now CIC. This is a company specialising in healthcare systems development across organisations in complex settings. Steve is a NICE Medicines and Prescribing Centre Associate; CQC Specialist Advisor; Associate Lecturer at Plymouth University and runs a Chapter of the Institute for Healthcare Improvement.