Surely there can be no other option but that a bottom up approach through accountable clinical teams lies at heart of the quality agenda. If the current system does clearly support a clincially-led patient-centered approach to care can real quality improvement occur? Is this an oportunity for Colleges to embrace the centrality of quality improvement as the core of good practice.
I agrre with Hugh McIntryre that individual clinical encounters are where value is added , or not , to patient care . Quality is in the eyes of the beholder . We need to ensure active listening is a fundamental part of training , acreditation and revalidation . Respect for patient and carer opinion ; and involvement of patients in service design , governance and quality improvement are fundamental to high quality care . Supporting patient leadership must be part of the response to the insights the Mid Staffordshire mirror is revealing . The seven dimensions of quality - safe, timely , efficient , effective , equitable , patient centred and sustainaable - are each measurable . Measuring quality at team level , sharing the informatiom with patients and using the knowledge that brings not just for external regulator or internal organisational purposes but primarily to improve individual patients care is needed across the system . In his first report Robert Francis eloquently made the point that behind every statistic there are individual patient stories . Volume 2 remains required reading .
I would take serious issue with the use of the term 'tragic events' in describing what happened at Mid Staffs. A tragedy is what happens when an unforseen or randon event results in suffering or loss to people who did not deserve such a fate. What happened at Mid Staffs was the result of negligence and failure in a basic duty of care on a massive scale from top to bottom in at least four significant organisations. It is to be hoped that lessons are learned and that, as well as justice for the people who were so badly let down, there is a genuine attempt to re-focus on the values and ethics which should be at the core of a public funded and run healthcare system, starting with the premise that hospitals should do no harm.
From my experience we face a cultural issue. Anna's report is right to pinpoint the need for boards to exercise oversight internally however the mindset of those on the board must be correct. The NHS is configured so that it is too easy to prioritise the needs of the organisation and ones place within it. Individual and organisational ambition need to be tempered with a commitment to, if necessary, act in opposition to the organisational status quo to protect patients.
Surely Anna is jumping the gun in her final comment that we risk focusing too much on the national regulators. Arguably we have never really researched the impact of the arms-length regulation model (essentially the regulated market of the privatised utilities as applied to the NHS) and that is something that urgently needs investigation. Presumably the influence of voices like Anna's lie behind the NIHR's decision to exclude regulation at the national level from its recent call for research proposals on governance post-Francis. I'm afraid that I believe that this emphasis is premature and may have an ideological component - i.e. it suggests a preference for discussing micro-level cultural issues as opposed to issues of system design.