Following the Francis report into the breakdown of care in the NHS system in Mid Staffordshire hospitals, David Cameron requested Don Berwick a renowned international patient safety expert to form an advisory group, to guide the changes required within the NHS to ensure patient safety.
The Berwick report describes some of those problems (view report). Among them are a partial loss of focus on quality and safety as primary aims, inadequate openess to the voices of patients and carers, insufficient skills in safety and improvement, staffing which was inadequate for patients’ needs, and very unhelpful complexity and lack of clarity and cooperation among regulatory agencies. He states in his letter to senior NHS management & government officials (view here) that all these problems can be remedied: “In trying to achieve remedy, your most certain and productive pathways will be built on the enormous strengths of the NHS – its people, their commitment, its charter, much of its track record, and the affection and wisdom of patients and carers. I hope that you will invest even more than ever before in learning, growth, development, ambition, and pride. This is the route that can make the NHS a “learning organization” in every sense of the term, and it can unleash momentum for improvement that no simple, top-down, control oriented, requirement-driven culture ever can”.
Berwick urges that reckless or neglectful behaviour rarely occurs, but must not be tolerated and there is an important role for responsive regulation by experts, proper enforcement and appropriate consequences for such actions.
But acting on rare poor performance will not make the NHS safer and better- it is a culture of learning that can. “The likelihood of such a culture’s thriving in the NHS depends, more than on anything else, on how you, the senior leaders, behave, speak, and invest”.
Berwick in his letter to senior management has suggested 4 guiding principles that will assist every step forward :
● Place the quality and safety of patient care above all other aims for the NHS. (This, by the way, is the safest and best route to lower cost.)
● Engage, empower, and hear patients and carers throughout the entire system, and at all times
● Foster wholeheartedly the growth and development of all staff, especially with regard to their ability and opportunity to improve the processes within which they work.
● Insist upon, and model in your own work, thorough and unequivocal transparency, in the service of accountability, trust, and the growth of knowledge.
Berwick concludes his letter with “I urge you to focus on the culture that you want to nurture: buoyant, curious, sharing, open-minded, and ambitious to do even better for patients, carers, communities, and staff pride and joy”.