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Twitter idiots, Don Berwick and a real answer to the NHS problems

August 7, 2013

A lot of rubbish being spouted in the press today and on Twitter about Don Berwick’s report, various individuals trying to pick out certain words to support their entrenched position and biases. In the week that people have called for systems to prevent abuse on Twitter, could we not also demand a system to prevent bland comments by people who like the sound of their own voice/tweets, but are not actually part of the solution?

Not sure if healthcare and the NHS attracts more than other sectors, but there seems to be an endless, tedious stream of retired hospital managers, ex-GPs, and self-appointed “saviours of the NHS” who have had a nocturnal vision that their thoughts have some value to others. Reality check: merely writing on Twitter is not solving the problem, helping the NHS or even vaguely innovative, creative or useful. The future is created by those who are doing something, facing big problems, taking big risks and putting their careers, reputations and passion on the line to fight for patients and for a better NHS. Like some of those described below.

So, what has this got to do with Don Berwick’s report and making the NHS better. For the King’s Fund, Catherine Foot said of the Professor’s work: “…the principles and recommendations are not new and echo the findings of previous reviews – the question remains how to make a patient-centred culture that takes safety seriously reality?” [my italics].

Well the good news is that the question doesn’t remain, it’s actually been answered by brilliant NHS staff up and down the country. These people – and their organisations – are nearly always outside of London are often not seen by the chattering/twittering classes. It’s hard to understand the brilliance of Hull, Swindon, Walsall and others if you haven’t visited them and had that wonderful sense as you walk through the door of “something happening”, an obvious atmosphere and the feel of a place that really cares.  Of course these places are somewhat inconvenient to visit for those based in London, and can’t easily be fitted around a “breakfast debate”, or “lunchtime networking event” – all of which happen within two miles of Westminster.

I have the huge privilege in my job of visiting NHS (and private) hospitals up and down the country, day in, day out (just arriving in Sunderland as I type). Spending every day meeting, talking to and working with NHS colleagues is a truly great job. I can tell you they don’t have “breakfast debates” in Hull, and I doubt there has even been a “lunchtime networking event” in Walsall. But it is in these places where Catherine’s question has been answered. These hospitals and their managers worked out the answers to the Berwick report years ago, have implemented solutions, and their patients and staff are already benefiting.

If – in-between planning the vital healthcare improvement that is done by hanging around the fringes of the forthcoming party conferences for yet more drinks receptions, brain-storming and networking – these “thinkers” want to see what a modern, patient-centred culture looks like, and the incredible impact it has on patients, staff and costs, then they should cancel their next strategy day and get a train to some of these places.

They will find:

1. Brave, bold, clear leaders who understand exactly what Jeremy Hunt meant when he said that coasting and tolerance of average performances should be unacceptable in the NHS. The CEOs of these organisations do not accept average, they are on a continuous journey to improve and are absolutely firm about removing all obstacles that slow-down or prevent this.

The answer is clear: no one should be leading any NHS organisation unless they are dedicated to excellence and improvement. Whilst the NHS continues to accept mediocrity of leadership, the problems will not be solved. This applies across the board: acute Trusts, CCGs, and within the huge bureaucracy that is NHS England.

Every successful organisation, whether a global company, charity, publisher or political party gets rid of mediocre leaders. Until the NHS does the same, it will never be the great thing it needs to be. If your local hospital or GP service is in the bottom 20% of the country then you should be calling for the resignation of its leader.

2. Real focus on the experience, opinion and realities of patients. All these great organisations have put in place continuous, real-time feedback systems for patients. Not some opaque, confusing annual survey, not some supermarket-style SMS feedback rubbish, but a totally open, honest and detailed “TripAdvisor of Health”. Every patient, every relative, and every member of staff can provide detailed feedback on what is great and what needs to be improved. Every word is published transparently on the internet – this is exactly the sort of thing Don calls for when he says that transparency has to be at the heart of the NHS.

[Declaration of interest: I’ve worked with Don at the IHI, delivered new projects for him and he has been a real personal support as iWantGreatCare has grown and developed.]

3. Staff who love challenge, are not scared of being shown where they could improve and remember that it is they who are lucky to have the patients, not the other way around. The best hospitals give every ward, every clinic and every department regular (e.g. weekly), detailed comparative feedback on their performance. This drives competition within NHS organisations and across the NHS, and – when done properly – staff love it. In every hospital I visit, without exception, the frontline staff want to know how well they are doing, they want to fully understand the experience of their patients, and they want to improve it. This is typified by one senior matron who, when congratulated on being the second best ward out of ninety-seven across their Trust for patient experience, put me in my place with a firm, “no, it’s not good enough, I want us to be the first and the best!”.

 

When organisations passionately focus on improving patient experience (not just making it a slogan on their website), all the other important stuff improves as well: staff morale, financial performance, clinical outcomes and safety (evidence and references on multiple previous blogs here). To make this happen, to answer the King’s Fund question and as a response to the challenges of Don’s report, the NHS needs to look at its best, look at its most improved, look at its most open and honest organisations.

Bruce Keogh spent a lot of time and money looking at some of the worst performing hospitals in the country. His recent report was widely welcomed and acclaimed as shining new light on the problems of the NHS. Could I suggest he now does a similar report on the best fourteen, a report that would show the NHS that the answer to what we repeatedly hear described as difficult and intractable problems are – for many NHS organisations – neither difficult, nor intractable.

 

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