The NHS: Putting Patient's Safety First?

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Written by Shane Tickell While the Francis Report was voluminous and in parts failed to give clear direction on next steps, the most recent Berwick Re...

Written by Shane Tickell


While the Francis Report was voluminous and in parts failed to give clear direction on next steps, the most recent Berwick Reportwas criticised for being ‘soft’ and ‘over simplistic’ but in its digestible 46 pages, it distilled the key issues that the NHS continues to face in putting patient safety first. At its most basic, it said learning and leadership must be wholeheartedly addressed.

But perhaps the difficulty in adding further detail to the report, which was said to be ‘light on practical solutions’, comes partly with a wider inability for people to describe what makes a good leader, a leader that encourages learning, is visionary, adaptive and responsible. To me all of these attributes come down to one key quality that every leader must exert ‘courage’.

As it stands, those who progress to lead a division or an organisation have traditionally obtained their status by being forward thinking, devising a plan, implementing the plan and claiming the success following the activity.

But what happens when, and increasingly in the NHS, plans change? This could be due to internal factors, such as resourcing issues or organisational changes or even external factors such as a large-scale medical emergency, a problem with a national helpline, or an ageing population.

Good leaders in my mind are those who have the courage to step up and say ‘this isn’t working, this needs to change’ or ‘things were different when we first started on this path, let’s reassess what we are doing’. This is irrespective of whether they devised the plan, signed it off, or oversaw it. The point is that great leaders are those who have the courage to take responsibility and move things forward regardless of whether they could be considered ‘wrong.’

Salford Royal NHS Foundation Trust is a clear example of where this has been achieved. Five years ago the trust was criticised for having some of the highest unnecessary death rates in the country. The trust realised its mistake and went public. Today it has the lowest mortality rate outside of London. In March, the hospital’s chief executive, David Dalton explained:“The nurses have to deal day-to-day with patients – and they know what works. We set about building a different culture – one which would allow nurses to look at the system and say how we could improve it.”

The Berwick Report focuses on the need for the NHS to become a ‘learning organisation.’ In virtually every industry, we expect our leaders to have all the answers and to radiate the conviction of being all knowing. I disagree with the term ‘born-leader’ and despite often being put on a pedestal, leaders like everyone else, must continue to learn, to improve and to ultimately succeed in making a change.

I read recently that in his retirement, Bill Clinton makes it a rule to say ‘I made a mistake’ or “I didn’t know that” once a day. Even if a scenario doesn’t naturally occur, he will go out of his way to engineer one.  He does this, as he believes this will help him to learn and look at situations from a different perspective. However, if he had changed the direction of his manifesto or political strategy during his presidency, he would have no doubt been ridiculed by the opposition the media and the nation alike.

The point here is that, those who lead should be respected for making the best decisions based on the best knowledge that they have at the time, whenever that time is. When things become challenging and circumstances change, this gets tough but having the courage to adapt a strategy or situation is likely to have far better results and can be far more rewarding.

In a recent article,Jan Filochowski, CEO at Great Ormond Street Hospital echoed these thoughts:“You'll always make mistakes ... it's about correcting them before they become really big.” He highlighted that there needs to be a change in NHS culture that does not see failure as an end point.

It takes boldness and bravery to take a step back and admit that decisions made early on might not have been the right ones but it takes courage to change and adapt in order to stop a strategy failing completely.


About the Author

Shane Tickell CEO, IMS MAXIMS


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