An inquiry published its findings early last year in the wake of a massive scandal. It had been commissioned to look into standards of practice and made recommendations for significant cultural change, as well as new legislation.
The reputation of the sector had been gravely damaged. Trust had fallen to a new low and shocking malpractice was exposed.
The report highlighted that risks and rewards had been out of kilter. The actions of regulators were called into question. Concerns were expressed about appropriate support for staff raising concerns.
Specific recommendations included: new powers for regulators; holding individuals more to account; new criminal offences; new tools and “special measures”; relinquishing political control; and more accountability.
Sound familiar? But here’s the thing: it’s not about health, it’s about banks.
Like the NHS, the banking sector was subject to significant scrutiny of its culture in 2013.
Change takes time
The parliamentary commission report on banking standards acknowledged that profound cultural change takes time and effort over many years.
There were calls for banks to re-evaluate their core purpose and the values which should define behavioural expectations and norms.
But I think there is a significant difference between the banking review and the NHS.
I’m not that close to the banking sector but what seems different is the lack of proliferation of further banking reports, adding more and more diagnosis and complexity, as well as sometimes superficial or simplistic solutions to “fix” the problem.
Indeed, the banking commission emphasised that profound change takes time.
It seems to me that almost every week there are reports from various commentators – all legitimately pointing out where the NHS doesn’t get it right – mostly presenting “checklist” solutions and recommendations or recasting existing research as “new” findings.
Most also make the mistake of assuming the NHS is one single organisation rather than the complex system we know it to be.
We know that the culture, systems and processes that exist in a GP practice, a community clinic, a physiotherapy unit, a district hospital, a teaching hospital, a rural mental health facility and clinical commissioning group are all different.
They have common challenges but with different histories, leadership models and priorities.
Let me help confirm the diagnosis:
- Funding is limited and demographic changes affect the way care is provided. The NHS needs to change the way it delivers services, with effective people management playing a key part.
- Checklists, policies and procedures do not work in isolation. Change needs strong leadership.
- Leadership is the embodiment of culture. Real change will require culture change and it starts with leaders.
- Better staff engagement is essential. We know engaged staff lead to patients reporting better care.
- Regulation has a part to play but is not sufficient and is not a substitute for action by individuals and organisations.
- We need to invest more in line managers, training and development. Most are clinicians too and it is tough combining both roles. We need to support them, not blame them.
- We need greater patient involvement; learning from patient feedback goes hand in hand with listening to staff.
- We need to recruit, appraise and develop for the right values.
There you go – it’s enough to be getting on with isn’t it?
Time, space and support
In fact there has already been progress. A report by the Nuffield Trust highlights change to organisational culture already evident.
We know the diagnosis, we have collected the prescription and it’s starting to work.
Now instead of more reports – which we will all no doubt warmly welcome – let’s give our managers and leaders the time, space, support and encouragement to make a generational change and praise them when they do it well.
This blog appeared as an article in the Health Service Journal on 14 February 2014.