09 / 4 / 2013 10.12am
The top priority if we are to create cultures of high quality, compassionate and safe care for patients is that leaders at every level of the NHS prioritise a vision focused on such care. They must make it clear continually and at every level of their organizations that high quality, compassionate safe care is the core purpose of their organisations. This purpose must be in the DNA of their organisations so that all existing and new staff understand and live this commitment.
Ministers, Commissioning Board executive team, CCGs, Monitor, CQC, Trust Boards, Directorates, Departments and team leaders must all make it clear that high quality compassionate care is their purpose and priority. When any of these bodies adopts a different orientation they start to produce a corrosion of purpose in the NHS.
Productivity over high quality care
Targets, productivity, cost cutting, efficiency and meeting the needs of regulators are hugely important but high quality care must be the top priority. If productivity becomes more important than high quality care in the culture of the organisation, the road to another organizational level failure like Mid Staffs becomes very much shorter. And Mid Staffs is simply one end of a continuum not an isolated case. Cost effectiveness is vital given the demands on the service but Boards must be vigilant in ensuring that their concern with this does not appear in practice to trump a concern with delivering high quality, safe and compassionate care.
Actions speak louder than words
Visions are not just about statements they are about actions because the messages that leaders send about their priorities are communicated more powerfully through their actions than their words. It is what leaders monitor, attend to, measure, reward and reinforce that shapes the efforts of staff. If Boards spend more of their time in meetings discussing targets, efficiencies, productivity and costs than patient experience, quality of care and patient safety, that message permeates down through the organisation and shapes the culture accordingly.
Similarly, If senior leaders ignore staff concerns, dismiss staff stress, avoid discussing workload pressures and fail to deal with systems problems (blockages in patient pathways, unnecessary bureaucracy, inter-departmental conflicts) they undermine the espoused message of high quality care.
And when leaders treat staff brusquely, rudely, uncaringly and disrespectfully they create cultures where patients are treated brusquely, rudely, uncaringly and disrespectfully.
Vision and mission statements
However often repeated in writing and verbally, will not be trusted by staff who experience quite different cultures in practice. Cultures are about what we value, what we do and what we come to take for granted as the right way to behave. It starts with our visions of the kind of health care system we want for our society.