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We need a new culture in the NHS blah, blah, yawn, yawn

February 27, 2013


How NHS Trusts and CCGs can meet 10 of the Francis Report recommendations next week (and at no cost).

There’s a lot of gnashing of teeth and wailing from politicians, the NHS and the medical profession about how we need “real change” and “a new culture” post the Francis Report. Indeed if words (or in many cases Tweets) were change we’d already have a safer NHS, with increased transparency and better experience for all our patients.

The challenge of course is how to turn guilt, anguish, intention and passion into actions that actually do make the NHS safer, and which drive continuous quality improvement. Many of us remember, Sir Ian Kennedy telling us after the Bristol paediatric surgery tragedy that this would “never again” be allowed to happen – but here we are with at least another five disasters in the public domain and an unknown number still yet to be discovered.

iWantGreatCare was founded five years ago to help bring true transparency into healthcare, to capture the voice and opinion of patients and their carers and to turn patient experience into a robust quality metric. Working both in the UK and abroad this is exactly what the team has done, and – through inspiring partnerships with innovative, visionary and bold NHS leaders – the methodology has proven to be effective in monitoring, analysing and measurably improving quality of care, whilst at the same time building the morale of frontline clinicians. Bottom line:

Trusts using iWantGreatCare create, build and grow exactly the sort of culture that everyone is talking about now: one that is totally centred on the needs and experience of the patient and where the core values include transparency, honesty and candour.

Below are ten of the recommendations from the Francis Report that Trusts are able to meet immediately by deploying iWantGreatCare. This results from the unique way in which iWGC combines real-time, quantitative and qualitative, continuous feedback across all care settings, with detailed, comparative reporting and instant “hazard alerting”. Those Trusts which already use the service have delivered on each of the requirements below.

[The recommendations have been analysed by Dr Sebastian Yuen  who is rapidly creating a reputation as a clinician leader to watch in the realm of safety and quality – but who rather impressively manages to combine it with high clinical standards and wonderful compassion. Speak to him here.]

Recommendation 256 – A system for following up patients after discharge would provide a WIDER RANGE of feedback

Recommendation 255 – Qualitative Patient feedback needs to be made available to all stakeholders in REAL TIME

Recommendation 194 – Nurses to have mandatory annual appraisal, including “FEEDBACK from patients on care provided”

Recommendation 114: Comments which describe events amounting to adverse / serious untoward incident should trigger an investigation

Recommendation 112: Comments must be investigated whether or not the patient has a desire to have the matter dealt with as such. Feedback (not a complaint) which is cause for concern should be investigated as if it was a complaint

Recommendation 111: Constant ENCOURAGEMENT must be given to patients to share their comments/criticisms and providers must CONSTANTLY PROMOTE their desire to receive and learn from comments

Recommendation 109: Methods of registering a comment must be readily accessible and EASILY UNDERSTOOD

Recommendation 040: Greater attention should be paid to the NARRATIVE contained in e.g. complaints data, than to the numbers

Recommendation 036: REAL-TIME quality data must be available to providers/commissioners/regulators/the PUBLIC

Recommendation 035: SHARING of information between regulators needs to include ALL intelligence which may raise the level of concern

And of course, it’s not just acute providers that need to respond to the recommendations. Every Clinical Commissioning Group will need to ensure that in their planning, contracting and measurement of commissioned services they have met the demands of the Francis Report. For those CCGs who are wondering how to do this, you could do a lot worse than speak to the Cumbria CCG. The team there is embedding continuous, real-time, quantitative and qualitative feedback in their contracts with both acute and community providers – again meeting many of Robert Francis’ recommendations.

So, just maybe there is hope that the Francis Report can be a turning point, the moment that a line was finally drawn in the sand, and the beginning of an NHS that is always honest and open, and one in which quantitative and qualitative data is made available to all stakeholders – especially the most important one: the patient.

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