So the Berwick report is now making waves. Peacefully lapping against steadfast rocks. Why peaceful? Because the stress is again on the NO BLAME culture that has to thrive in the NHS for it to be the envy of the world. Business as usual I see.
I would read the Holy Bible usually if I wanted to feel good but now it seems there is another do-gooders' prescription on the block. Generic behaviours wish-list galore for the NHS. Feel good, exhilarating, hair raising feeling of goodness. Help everyone, dont kill your patients, love your neighbouring trust as thyself, forgive even CCG commissioners who denied you money to sustain your services , don't covet another hospital's money and such. A bit different in that there are only 8 commandments. Not exactly called commandments because in this day and age, commandments would be a politically incorrect word. Let us go with "Solutions" instead. If they could call it a guideline, they would but this time solutions turned out to be more popular around the table.
I have nothing against this report. To have something against it would make me look pretty much a bad guy who hates a good sermon in church. No, I like it, I like it, I like it. I promise. I enjoy reading it just as much as the next man {or woman, but I am not usually that lucky}. But that does not mean, I cannot see the lighter side of the recommendations. Or should I say, the darker side?
Use quantitative targets with caution. Goals in the form of such targets……should never replace the primary goal of better care.
In other news, What? Your hospital mortality is 116? It should be at 103! You are not delivering quality care because your quantitative target says otherwise. No, no, dont quote me the berwick report. That report won't run this hospital next year if we don't break even this year. Come on, come on. Solutions please. How many patients should each FY2 clerk in each day? How fast should a registrar respond to a sepsis call? The commissioners want 95.3% of discharge summaries to reach them before 12 midnight if we want our one million pounds. Do you think we could write to them to read solution 5 of the Berwick report? Keep another two copies of the Berwick report to be sent as response to the Monitor next month and the department of health the month after.
Ensure that responsibility for functions related to safety and improvement are vested clearly and simply in a thoroughly comprehensible set of agencies, among whom full co-operation is without exception, expected and achieved.
I can see the instant response to that statement everywhere in the NHS where people are waiting with open arms to make every paragraph of every report come true. Let us get rid of the current Quality improvement program at our trust and set up another committee named Quality Performance program. While we are at it, we could remove one or two of those clinicians who have been slowing down the quality goodies that have been waiting to be delivered. Or should we call it Quality Innovation productivity and prevention programme? Damn it, all the good ones have been taken. Give it another year, that may become available again.
Give the people of the NHS- top to bottom- career long help to learn, master and apply modern methods for quality control, quality improvement and quality planning.
I understand control, I understand improvement, I understand planning. What exactly was that "quality" bit thrown in three times in one sentence supposed to do? Would that make that sentence a very high quality statement? People love quality. I do. I ooze it. I know I know, you dont think so? Obviously we haven't met. Anyway, point is, one man's quality is another man's mediocrity. Tell me, when was the last time we rewarded quality? Er, No, that was just numbers, not quality. 20 discharges in a day is not quality. 99.5 % people transferred from one room to another wrong room within four hours is not high quality. 95% of toenail fungal infections seen within 18 weeks and treated is not quality. It would have been of some quality, but the fact that we had no space to fit in the 30% of patients who really needed to be seen urgently with failing hearts because we were busy with the nail fungus made it look a bit silly. Fact is, the people in the NHS who talk about quality are too busy writing or counting, to see the wood for the trees or the quality for the quantity. I realise I am writing as well, I should not be, I know.
Make sure that pride and joy in work, not fear, infuse the NHS.
Who? Me? Ok, Ok, I will make sure. Er, How? Not in my gift, sorry. I can't mollycoddle those looking and behaving like they know what they are doing but tremble with fear the minute they are called to explain themselves and their mis-behaviour. Oh you poor thing. You saw that the health care assistant switched off the patient's call-button without giving a commode straight away but you did not tell the HCA that it was unacceptable because you were shaking with fear? Or were you trembling with fear at the thought of having to live with a disgruntled HCA(s) ganging up on you for the rest of your life on that ward? Oh Honey, Why did you have to worry? We could have put you into a witness protection programme in an environment free of HCAs for the rest of your life to fearlessly practice nursing the way you always wanted it. Alright then, I see that fear has made you very unsafe. Take the day off tomorrow. There are only 2 nurses for 26 patients tomorrow but take the day off anyway, because your body language tells me you are going to throw a sickie anyway. See you next Wednesday. Please take care not to work in fear. Feel free to take pride in your work from home. When exactly are we going to tell people to take pride and joy in work despite the fear?
Good mind-cleansing, sin-dissolving, feel-good talk is fine. But who is going to ensure that EVERY person working in the NHS lives that talk rather than just talk the talk when it suits them? We now live in an NHS environment and training environment where standards have been lowered to get anyone into the workplace and then expect everyone to share the ethos of caring and sharing. There is no more selection happening of committed people. We just hope that being in the shadow of the NHS logo transforms anyone entering, into shining individuals with concern for patients bubbling in their beating hearts. We are also gullible enough, or we choose to be gullible enough to believe that a 46 page document of goodwill will make them contrite, melt their heart and drive them to passionate work on a daily basis. And if it does not turn out that way, please dont blame them. We operate a No blame culture in the NHS.
I would read the Holy Bible usually if I wanted to feel good but now it seems there is another do-gooders' prescription on the block. Generic behaviours wish-list galore for the NHS. Feel good, exhilarating, hair raising feeling of goodness. Help everyone, dont kill your patients, love your neighbouring trust as thyself, forgive even CCG commissioners who denied you money to sustain your services , don't covet another hospital's money and such. A bit different in that there are only 8 commandments. Not exactly called commandments because in this day and age, commandments would be a politically incorrect word. Let us go with "Solutions" instead. If they could call it a guideline, they would but this time solutions turned out to be more popular around the table.
I have nothing against this report. To have something against it would make me look pretty much a bad guy who hates a good sermon in church. No, I like it, I like it, I like it. I promise. I enjoy reading it just as much as the next man {or woman, but I am not usually that lucky}. But that does not mean, I cannot see the lighter side of the recommendations. Or should I say, the darker side?
Use quantitative targets with caution. Goals in the form of such targets……should never replace the primary goal of better care.
In other news, What? Your hospital mortality is 116? It should be at 103! You are not delivering quality care because your quantitative target says otherwise. No, no, dont quote me the berwick report. That report won't run this hospital next year if we don't break even this year. Come on, come on. Solutions please. How many patients should each FY2 clerk in each day? How fast should a registrar respond to a sepsis call? The commissioners want 95.3% of discharge summaries to reach them before 12 midnight if we want our one million pounds. Do you think we could write to them to read solution 5 of the Berwick report? Keep another two copies of the Berwick report to be sent as response to the Monitor next month and the department of health the month after.
Ensure that responsibility for functions related to safety and improvement are vested clearly and simply in a thoroughly comprehensible set of agencies, among whom full co-operation is without exception, expected and achieved.
I can see the instant response to that statement everywhere in the NHS where people are waiting with open arms to make every paragraph of every report come true. Let us get rid of the current Quality improvement program at our trust and set up another committee named Quality Performance program. While we are at it, we could remove one or two of those clinicians who have been slowing down the quality goodies that have been waiting to be delivered. Or should we call it Quality Innovation productivity and prevention programme? Damn it, all the good ones have been taken. Give it another year, that may become available again.
Give the people of the NHS- top to bottom- career long help to learn, master and apply modern methods for quality control, quality improvement and quality planning.
I understand control, I understand improvement, I understand planning. What exactly was that "quality" bit thrown in three times in one sentence supposed to do? Would that make that sentence a very high quality statement? People love quality. I do. I ooze it. I know I know, you dont think so? Obviously we haven't met. Anyway, point is, one man's quality is another man's mediocrity. Tell me, when was the last time we rewarded quality? Er, No, that was just numbers, not quality. 20 discharges in a day is not quality. 99.5 % people transferred from one room to another wrong room within four hours is not high quality. 95% of toenail fungal infections seen within 18 weeks and treated is not quality. It would have been of some quality, but the fact that we had no space to fit in the 30% of patients who really needed to be seen urgently with failing hearts because we were busy with the nail fungus made it look a bit silly. Fact is, the people in the NHS who talk about quality are too busy writing or counting, to see the wood for the trees or the quality for the quantity. I realise I am writing as well, I should not be, I know.
Make sure that pride and joy in work, not fear, infuse the NHS.
Who? Me? Ok, Ok, I will make sure. Er, How? Not in my gift, sorry. I can't mollycoddle those looking and behaving like they know what they are doing but tremble with fear the minute they are called to explain themselves and their mis-behaviour. Oh you poor thing. You saw that the health care assistant switched off the patient's call-button without giving a commode straight away but you did not tell the HCA that it was unacceptable because you were shaking with fear? Or were you trembling with fear at the thought of having to live with a disgruntled HCA(s) ganging up on you for the rest of your life on that ward? Oh Honey, Why did you have to worry? We could have put you into a witness protection programme in an environment free of HCAs for the rest of your life to fearlessly practice nursing the way you always wanted it. Alright then, I see that fear has made you very unsafe. Take the day off tomorrow. There are only 2 nurses for 26 patients tomorrow but take the day off anyway, because your body language tells me you are going to throw a sickie anyway. See you next Wednesday. Please take care not to work in fear. Feel free to take pride in your work from home. When exactly are we going to tell people to take pride and joy in work despite the fear?
Good mind-cleansing, sin-dissolving, feel-good talk is fine. But who is going to ensure that EVERY person working in the NHS lives that talk rather than just talk the talk when it suits them? We now live in an NHS environment and training environment where standards have been lowered to get anyone into the workplace and then expect everyone to share the ethos of caring and sharing. There is no more selection happening of committed people. We just hope that being in the shadow of the NHS logo transforms anyone entering, into shining individuals with concern for patients bubbling in their beating hearts. We are also gullible enough, or we choose to be gullible enough to believe that a 46 page document of goodwill will make them contrite, melt their heart and drive them to passionate work on a daily basis. And if it does not turn out that way, please dont blame them. We operate a No blame culture in the NHS.