NHS reform: missing something fundamental
In The guardian, Tony Yeaman comments: “Prof Don Berwick’s report Improving the Safety of Patients in England follows a long line of investigations into failures in care within the NHS and a plethora of responses to them; and yet we are no closer to the solution of the wide-ranging problems”.
As Yeaman doesn’t go on to give the solution I think is being missed, here it is.
It’s a truism that you can’t expect others to do what you’re not prepared to do yourself. You can’t expect your staff to treat patients to the high standard the Berwick report demands if you’re not prepared to treat them to the same high standards.
If it is felt that patients are not given a high enough level of care, it is essential to, at least, ask the question, “In what ways are staff not being given a high enough level of care?”.
Yet, of the ten recommendations made by the report, none of them makes any reference to how the wellbeing of staff is to be improved, how their approach to their job might be improved or changed, and in what ways.
Recommendation 6 states, “[NHS] leaders should create and support the capability for learning, and therefore change, at scale, within the NHS”. Learning is, of course, a necessary requirement for change, but it is hardly sufficient.
Part of the problem is in the title of report itself, “A promise to learn—a commitment to act”. Acting (differently) isn’t enough. What the NHS needs is not a new way of acting, what it needs is a new way of being.
All human behaviours (acting) are driven by emotions and feelings, and by thoughts and beliefs. Unless interventions are made primarily at these levels, the effort and resources needed to achieve and maintain the changes desired will be prohibitive [because the new behaviours will constantly be undermined by a tendency to revert to old behaviours].
A new way of being means a new attitude. Attitude is that complex mix of interacting emotions and feelings, thoughts and beliefs, which determines behaviour.
Putting aside the question of whether the phrase “create… the capability for learning” has any useful or useable meaning, I believe that recommendation 6 should be couched something like “NHS managers should create and support an environment which maximises the levels of care of both patients and staff, and in which they and the organisation can thrive”.
Creating such a facilitating environment is a key quality of leaders. To the extent that managers aren’t sure how to do this is an indication of their need to learn how to be good leaders. And it will have to start at the top, Mr Hunt.
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