This report summarises the main findings of the Francis Inquiry into the failings of care at Mid Staffordshire in relation to NHS leadership and culture. It sets out what needs to be done to avoid similar failures in future, focusing on the role of three key 'lines of defence' against poor-quality care: frontline clinical teams, the boards leading NHS organisations, and national organisations responsible for overseeing the commissioning, regulation and provision of care.
The report presents findings from The King's Fund's 2013 leadership survey. It also highlights the lessons that can be learnt from the experiences of high-performing health care organisations in other countries that have succeeded in developing effective leadership and a culture that puts patients' needs first.
Key findings
The leadership of the NHS at a national level needs to create conditions in which local organisations have the freedom to deliver consistently high standards of care and where the needs of patients come first.
The quality of care provided by NHS organisations should, first and foremost, be a corporate responsibility under the leadership of boards, who must lead by example by focusing on the quality and safety of care.
Leaders need to value and support frontline staff and ensure the main focus is on patients and their care.
Leadership development should give priority to supporting leaders at all levels to be patient-centred and to ensure that staff have the time and resources required to deliver high-quality care.
Patient leaders should work alongside NHS leaders to support the transformation called for in the Francis Inquiry report.
Policy implications
The NHS at national level must shift the predominant organisational culture from one focused on meeting externally imposed standards and targets to one in which NHS leaders and frontline clinical teams are committed to improving care and putting patients' needs first, working together to access the support they need to do so.
NHS organisations must abandon the traditional individualistic model of leadership and embrace a leadership style that is shared, distributed and adaptive. Board members in particular are responsible for setting the tone for their organisational culture, and should do more to actively seek and listen to the views of patients, governors, commissioners and staff.
It does make me reflect on how many times in my career we have had central directives, policies and position papers that call for public services to be more patient-centred. Yet nothing seems to change- why not?
In one sense, being patient-centred is blindingly simple- no patient should be treated with anything other than enormous compassion, dignity and respect.
Over and above these basic human rights though, being patient-centred is remarkably hard to define- it will mean different things in different contexts.
Most clinicians want to do good (beneficience) and not do harm (non-maleficience). They will in general try to do good according to their own set of underlying values and ethical principles- many of which will be informed by the context within which they usually work.
GPs, for instance, often tend to think of themselves as patient advocates- on the whole, they think of patient-centredness as being benficience through support for autonomy. In this context, being patient-centred might well mean giving patients information, choice and control
On the other hand, a cardiac surgeon might well define being patient centred as being as good a technical operator as they can possibly be. As a potential future patient of a cardiac surgeon- I know this is what I would want. According to the principle of utilitarianism, this 'task-oriented' approach to their work might mean that on occasions- in urgent clinical situations for instance- performing the task well becomes more important than supporting patient autonomy.
The point is, we need to be much clearer about what being patient-centred actually means. And we need to be much clearer about what being patient centred means in different contexts. And over and above this, we need to clarify not just the attitudes and values that mark out good patient-centred care in different contexts-- we need to exemplify, teach and measure the behaviours and skills that we (and more importantly patients) want our workforce to employ
The question has always been how to actually implement this. For those that are interested in answering this question, I would refer them to: www.themeaningofcareful.com/organisations for a suggested structure.
I agree with these observations and am of the view that we need to reframe our approach. Instead of thinking and acting in a way that focuses on 'what is the matter with the patient'. We should consider 'what matters to the patient'. This should not crowd out the technical and scientific parts of being a healthcare professional but create a balance that ensures that the patient and their expressed preferences are blended with our professional knowledge and a negotiated path forward co-produced. This is what the majority of good clinicians do and needs to be explicitly coached for and encouraged now that evidence based practice is so clearly defined that we may inadvertantly overlook what matters most to the patient.
"We must shift the culture from meeting externally imposed targets". Yes. There is one very simple way to do this, which goes like this:
Abolish the targets.
Are you brave enough to say this? Because amid all the noise about changing culture I don't see this simple statement being made. Unless you remove the targets, there will always be pressure to meet them, whatever. When you do remove the targets, all of them, for ever, you will be left with an understanding of the purpose of the NHS and the professional motivation of all the players to achieve it. Given what we know of the motivation of NHS staff, that sounds rather powerful to me.
Really great document and great to see Patient Leaders on the agenda of change!
It's about time patients should be seen as untapped assets; NOT problems to be "fixed".
Patient Leaders need investment & support if we're going to have meaningful & lasting impact on the system we all care about!
@Patient_Leader
It would be worth looking at the Leadership and Management Framework as a possible way of approaching the issue with an objective criteria. Accreditation against the Framework could be a useful goal to aim for.
There is real hope here. The NHS in some ways lags behind other industries and can therefore learn and borrow where the contextual commonalities exist. I am referring to gas and oil, rail and aviation in the UK. Their focus has not been patient care but passenger, public and workforce safety in a highly regulated and ever decreasing resource pool environment. There has been so much work and real progress made in open reporting , learning, leading cultural change etc. I have been part of this in Rail and have a background in the NHS.
Comments
It does make me reflect on how many times in my career we have had central directives, policies and position papers that call for public services to be more patient-centred. Yet nothing seems to change- why not?
In one sense, being patient-centred is blindingly simple- no patient should be treated with anything other than enormous compassion, dignity and respect.
Over and above these basic human rights though, being patient-centred is remarkably hard to define- it will mean different things in different contexts.
Most clinicians want to do good (beneficience) and not do harm (non-maleficience). They will in general try to do good according to their own set of underlying values and ethical principles- many of which will be informed by the context within which they usually work.
GPs, for instance, often tend to think of themselves as patient advocates- on the whole, they think of patient-centredness as being benficience through support for autonomy. In this context, being patient-centred might well mean giving patients information, choice and control
On the other hand, a cardiac surgeon might well define being patient centred as being as good a technical operator as they can possibly be. As a potential future patient of a cardiac surgeon- I know this is what I would want. According to the principle of utilitarianism, this 'task-oriented' approach to their work might mean that on occasions- in urgent clinical situations for instance- performing the task well becomes more important than supporting patient autonomy.
The point is, we need to be much clearer about what being patient-centred actually means. And we need to be much clearer about what being patient centred means in different contexts. And over and above this, we need to clarify not just the attitudes and values that mark out good patient-centred care in different contexts-- we need to exemplify, teach and measure the behaviours and skills that we (and more importantly patients) want our workforce to employ
Abolish the targets.
Are you brave enough to say this? Because amid all the noise about changing culture I don't see this simple statement being made. Unless you remove the targets, there will always be pressure to meet them, whatever. When you do remove the targets, all of them, for ever, you will be left with an understanding of the purpose of the NHS and the professional motivation of all the players to achieve it. Given what we know of the motivation of NHS staff, that sounds rather powerful to me.
It's about time patients should be seen as untapped assets; NOT problems to be "fixed".
Patient Leaders need investment & support if we're going to have meaningful & lasting impact on the system we all care about!
@Patient_Leader
Many Thanks
Hildegard
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