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15th October 2015 3

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New Health Chat

21st October King's Fund 5.30pm

Former boss of Addenbrooke's Keith McNeil

SOLD OUT, wait list ... here.

The F word

News and Comment from Roy Lilley

If you are of a nervous disposition, press delete. I am going to use the 'F' word. I think we should use more often.

I'm going to talk about failure.

Let's start with some simple misconceptions. JK Rowling, author of the Harry Potter books; rejected by a dozen publishers. She kept going. That's not failure that's persistence and perspicacity with a bit of luck.

How about the light bulb-bloke? Edison. He says he has never failed; he just found 10,000 ways not to make a light bulb.

Michael Jordan, basketball player; this is what he says:

"I have missed more than 9,000 shots in my career. I have lost almost 300 games. On 26 occasions I have been entrusted to take the game winning shot, and I missed. I have failed over and over and over again in my life. And that is why I succeed."

Is that failure or determination? Well, if he learned from his missed chances, changed his game, learned to block out the moment and focus... that might be learning from failure.

It's easy to confuse 'failure' and wrap it in all sorts of things it is not. And, it is certainly not always a nose-dive, bomb or go pear-shaped.

Almost all of human achievement and progress has been based on failure. Scientific experimentation is just another way of saying, fail enough times and eventually you'll find the right way.

The history of aviation is written in failure. Serious failure that cost people their lives. But, each time there has been a failure we have looked, looked again and learned lessons. We are safe because others have not been. At a time when we thought we were doing our best, accident and misadventure soon demolished our pride into the ruined rubble of people's lives.

Healthcare is no different. The history of medicine is full of well-intended people doing the wrong things, blithely unaware that there was a better way.

People had their lives taken by clinicians who thought they were doing the right thing. Our safe care today is built on the foundation of the lives it has cost and the unwitting damage we have done.

All of human progress has been built on failure. Buildings are safer because we have learned from failing foundations, roof beams and fire stops. Trains and railway tracks, fairground rides, cars and ships. Where ever there is failure there has been learning, understanding and progress.

It is only by opening our minds, our hearts, our ears and our eyes to failure; to look for it, listen for it, think about it will we ever find that fickle friend.... success. Even then it can be plucked from our grasp by another failure. Another 'take your eye off the ball' moment, a forgetful moment or a moment where someone didn't speak up.

Recognising the key role 'failure' has in success is the first step in a long journey to where the management bugle no longer drowns out the whistle blower.

Who, in their right mind, running an organisation that deals, daily, in the life and death of its 'customers' would not be interested in failure. To ignore failure is to invite catastrophe.

Complex healthcare is a fertile place for error and failure yet we pillory staff who reveal theirs and others shortcomings; teach them nothing about the value of errors, give no training in error management nor the skills to detect them, neither the facility to share and learn from them.

For dread of prosecution, humiliation, or being ostracised, condemned by our peers, shunned by the people we work with; we know whistle-blowers still end up getting the sack. We know fear of regulation leads to cover-ups, denials and has contributed little to safer care.

If we want people to ring the bell, shine a light, speak out we have to understand the paradox of failure. Failure has to become an ally in the battle for safe care and our partner in progress.

If learning from failure is good enough for F1, NASA, Boeing and BA, it's good enough for the NHS.

An error with drugs, diagnosis, procedure, operation, poor care it doesn't matter what it is; it is a precious gift that the victim would rather not have donated to the sum of our knowledge but when we have it, it is an obligation upon us to respect it, cherish it, learn from it and make sure we share it... so that never again will that unsolicited sacrifice be needed.

Use the F word, make it a friend.

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Medicine for Managers

Dr Paul Lambden

Lumbar Puncture

Can anyone define 'a little pain...'

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News and Stuff

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>> Pay cap for agency staff - this will be welcomed by Trusts but looks full of holes to me? The link is to the HSJ report and the comments are interesting; scroll down. BBC report here.

>> Stevens on the future of funding and the �8bn - this is the HSJ report on Tarzan's speech at the King's Fund on Tuesday. He'll use it to remap healthcare and bring in (all but) population based, capitated budgets. This is a must read.

>> Move to resolve contradictory messages about safe staffing and money - Here's the letter to all Trust bosses. By the looks of it, it has done anything but! This is a letter, signed by 5 organisations (!), My reading; abandoning NICE guidance and telling Trusts to use their common-sense. What else can they do - there's not enough money for enough nurses and if there was, there ain't enough nurses. Will Robert Francis step down from the CQC, or will he turn a blind eye?

>> Backtracking on safe staffing - I guess we won't know what safe is until something happens to tell us it wasn't. I wonder what Robert Francis will think as he sees his work going down the toilet. Will he resign from the CQC?.

>> CQC (them again) - apparently they (we) stumped up £6k for their Chairman (Lord Prior) to go on a jaunt to the US. Is there anyone in charge at the CQC? Do they have a Board, or do governance?

>> Ignore NICE guidance - yes, it's official, you can. Nothing to do with the fact we can't afford to follow it?

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HealthChat

1st December

King's Fund 5.30pm

Janet Davies

New boss at the RCN

King's Fund 1st December 5.30 pm.

Details here.

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Health Chat

21st October

King's Fund - 5.30pm

Keith McNeil

Sold out

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19th November

King's Fund 5.30pm

Lord Hunt

Labour's Health Leader in the Lords.

A remarkable career; from leader of NAHAT (a forerunner of the Confed) and Trust Chair to the front-line of politics.

This will be an absorbing evening of politics, policy and no few insider secrets (we hope). In conversation with Roy Lilley; come and hear from the heart of Westminster.

Details here

and

Philip Hunt writes here

Guest Editorial

the NHS in crisis and Monitor's new clothes.

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Gossip

This is what I'm hearing;

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tell me here

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>> I'm hearing - two new national leads are appointed; Jonathan Fielden (specialised services) and Arvind Mada (primary care). Interesting that Mada is a major shareholder in the Hurley Group who develop and sell webGP. Will he sell his share holding or put the in Trust for the duration? If it looks like a conflict of interest, it probably is.

>> I'm hearing - our favourite GP Dr Phil has taken the Queen's shilling and is fronting a new movie on identifying radicalisation. By all accounts, it's not as good as his stage show.

>> I'm hearing - the Confed has joined the Tory Party and appointed ex health minister Stephen Dorrell as their new chair.

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The Gooroo