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Go West to save and improve the NHS

Roger Kline, 1 March 2013

Macho management of healthcare has had its day. Command and control is outdated. Money must be the servant not the master.

Those were some of the key messages I took from an inspiring lecture at the King’s Fund in London this week by Professor Michael West. You can see it online here.

Professor West's research over two decades has shown, to put it crudely, that if you take good care of NHS staff they will take good care of the patients.

It is an inspring message, strongly rooted in the occupational psychology work of Professor West and his colleagues at Aston and Lancaster universities.

Coming three weeks after the Francis Report, and in the same week that the national NHS staff survey confirmed widespread lack of trust in management, the lecture showed what the new culture must look like and why it is essential.

It drew on work funded by the Department of Health showing that the more staff work in (effective) teams the fewer deaths will follow emergency surgery, to give just one example of the hard evidence Professor West presented.

The data he cited – and you can find the detailed research online here and here – show that:

  • how staff are managed is the decisive influence on quality and safety
  • the level and nature of staff engagement is the best predictor of patient outcomes
  • organisations in which staff are consulted on important issues and able to influence them, and have postiive attitudes to their leaders, have greater patient satisfaction and are more likely to be ‘learning organisations’.

But for this evidence to be embedded in operational practice, leaders must challenge behaviours that undermine and corrode such a culture, such as the bullying and punitive approach that Francis and other evidence show to be so widespread in the NHS.

The culture needed, and which the Mid Staffs tragedy tells us is a precondition of better, safer care, is one which whose core values Michael West summarised as having
• a commitment to learning
• the courage to stand up for what we believe in
• humanity and kindness
• justice and transparency in which people are treated fairly
• self regulation to permeate change for the better
• wonder and spirituality recognising that humour and “giving” are important

In such a healthcare organisation staff and their teams need time to reflect – and allowing that time doesn't undermine productivity but improves it.

I found this inspiring. I think the rest of the audience did to. It is so close to the principles Public World was founded on. It is what most whistleblowers and the best managers aspire to.

But this week also brought not only NHS Staff Survey results showing how far from the required culture we actually are but also the latest steps towards NHS privatisation by a government determined to learn all the wrong lessons from Francis.

We are at a crossroads. Professor West, after Francis, has pointed the way. They have shown what is needed to secure the NHS as a public service that puts safety and standards first. The challenge for the rest of us is to make it happen.

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