Promoting a culture of high-quality care

Following his leadership lecture at the Fund, we asked Michael West about how to foster cultures that promote high-quality care, particularly in light of the Francis Inquiry report.

Can you suggest ways in which NHS leaders can foster a culture promoting high-quality and compassionate care?

Leaders at all levels shape culture so they must adopt and model a set of common values primarily focused on providing high-quality, safe and compassionate care to all who use the health services. This requires that ministers, senior policymakers, regulators, trust boards, clinical leaders and frontline leaders recognise that they must prioritise such care in all they do, and not just in what they say.

Boards must make it clear that such high-quality care is their priority. Many will claim it is, but the evidence shows an alarming gap between leadership rhetoric and practice throughout the NHS. Progress requires compassion in practice, not just in words.

Is there any evidence linking leadership and management approaches with how patients feel about their treatment?

Analysis of the national NHS staff survey and NHS patient satisfaction surveys over the years shows a very clear link between staff views of their leaders and patients’ perceptions of the quality of care they receive. Leaders have a great influence on staff experience and we know that staff satisfaction and commitment are associated with patient satisfaction. Where staff feel they are treated with respect and have the support and trust of their immediate managers, patients report that they receive better care and that they are treated with appropriate respect, dignity and consideration. In general, positive staff views of their leaders are associated with lower levels of patient complaints.

Where leaders shape a positive, supportive, cohesive, optimistic emotional environment, patients report better care and there are low and declining levels of patient mortality. It is simple really – if we want patients to be treated with respect, dignity and compassion, we must treat staff with respect, dignity and compassion.

How can leaders foster high-involvement cultures’?

The best predictor in the national NHS staff survey of patient outcomes across all NHS trust types is the level of employee engagement. The level of staff involvement in decision-making is crucial. It predicts patient satisfaction, quality of care and even financial performance. Given the current challenges facing the NHS, we need ideas for new and improved ways of delivering care from board level through to ward level and especially ideas that come from patients. I believe that NHS frontline staff are about the best educated and most motivated staff grouping anywhere. Yet instead of releasing their innovation we have created command and control cultures with excessive bureaucracy and hierarchy that stifle creativity and innovation. We need work environments where staff know their priorities, and have challenging objectives and high autonomy.

Purpose and freedom empower people to implement better ways of delivering care. The most productive and innovative NHS teams regularly get off the hamster wheel and take time out to review what they are trying to achieve and how they are going about it.

Can you explain how working in a well managed team leads to more motivated staff and better patient care?

Fewer than 50 per cent of staff work in real teams in the NHS. Most are working in looser groupings that don’t have clear objectives and don’t meet regularly to review their performance. This can lead to high levels of errors, accidents, patient neglect and mortality. The challenge is to clarify where we need teams and what their task is. Every team should set around five or six specific, very challenging and measureable objectives each year, one of which should be improving how they work with other teams in or outside their trust. Team members should be clear about the role each of them plays. And teams should regularly take time out to review their performance and consider how it can be improved.

Teams should have positive climates, characterised by optimism, cohesiveness, mutual support and a sense of efficacy. When you have those elements in place, teams are more effective and innovative; team members have better health and wellbeing; and patients are much more satisfied with the care they receive.

What values can NHS leaders focus on to foster a more patient-focused culture?

Collectively, NHS leaders must have the courage to offer an inspiring vision focused on delivering high quality, compassionate care and the courage to be persistent in developing patient-focused cultures. They need to focus on wisdom – learning constantly about how to create such cultures from examples within the NHS and outside; constantly seeking input from patients and then acting on that knowledge.

NHS leaders must model humanity, which is at the core of a caring culture. And justice is fundamental to staff trust. Leaders must treat staff fairly, supportively and with respect. Leaders must also be prudent, resisting impulsive decisions to implement more exhausting initiatives; and help find innovative ways of helping staff manage workloads. Finally, values of connection are fundamental – gratitude and appreciation; optimism and humour; and a sense of the powerful influence of the NHS through its promotion of caring throughout our society.

This article appears in the summer 2013 edition of Insight magazine.

More on leadership and the Francis Inquiry report

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