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15th December 2015

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Health Chat

14th January King's Fund 5.30pm

Professor Sir Cyril Chantler

This will be a great evening! Must come!

The inside story of the history of the NHS and what next!

Tickets here.

Fix the system

News and Comment from Roy Lilley

In the best of well-run organisations, from time to time, things go wrong. It is the measure of that organisation how well and quickly, things are put right and what is put in place to make sure it can't happen again.

... the best business common sense I can muster for a Tuesday morning. I might as well not bother...

Creating an open environment, a climate where our foibles and failings don't light the fuse that explodes reputations, careers and confidence has been beyond the NHS since 1948.

In an excellent and very frank interview, with the HSJ, Tarzan says he believes the NHS to be at a 'cultural turning point' in the way in which it responds 'when things go wrong'. I don't see it that way. As regulation becomes more entrenched, complaints will be dug deeper.

The health service is a high risk business. Get it wrong and people get damaged or die. Families and loved ones scarred for life. Apparently, each year there are over a quarter of a million mistakes, causing harm to patients and maybe 25k deaths.

Set against the millions of people treated, I'm surprised there are not more... there probably are, we just don't know.

All improvement is built on errors; we start out doing our best but when we discover it's not good enough, we must do our best to find out what is the new best and do that.

Complain? To tell you the truth; I have no idea how I would go about complaining.

I do know I'd likely get bogged down, tied-up, delayed and exhausted. I know I would have to buy box-files to keep the correspondence. I know I would surrender hours, spend goodness knows how much. Watch my life slip through my fingers. Go from customer to campaigner? Patient to activist? For what? Something like:

"The [insert name of the organisation] apologises for an untypical set of circumstance where our care fell short of the high standards we expect.... blah, blah.... Learned lessons.... Taken on board... blah, blah..."

I might create a Twitter-Storm, wage war with Facebook and all the rest. Would I enter the labyrinth that is the NHS complaints system? No.

The NHS has systems designed to exhaust you, fob you off. Unlimited access to lawyers and press officers that work from glass towers with no front doors. They have nothing to lose by delay and obfuscation.

And, the pivotal issue; clinical negligence systems that are part of the culture of blame that encourages all of the above. Until the spectre of the GMC, CQC, regulation and punitive management is busted wide open, for staff, shutting your mouth and looking the other way remains the best option.

Every step, weighted against the complainant and the informant. A system with no understanding that perception is everything. No matter how skilled the staff, how good the training, how accomplished the management. If it don't look right from the customer's perspective; it ain't right!

Tarzan says the NHS has a problem; 'hearing families' voices'. That's because the system is sound proofed. What to do? Shout louder? No. There must be quieter and cleverer things...

No fault compensation, cut the role of the GMC to the keeper of registers, make the employer responsible. Abolish the system of clinical negligence. Independent case note reviews. Restorative justice. Reward reports of sentinel events. A national system of recording and analysing complaints and compliments. Publish performance data...

Make your own list.

The problem; bad news is headlines but gradual improvement and careful changes are not. Hence the NHS has become a coral reef of initiatives and guidance, products of knee jerk management and a culture of tinkering.

When things go wrong and we don't say so, we don't just fail our patients. The bigger failure is not delivering the bad news to each other because that's how we stop learning and organisations fail.

What do patients want? My guess, they want us to;

"... listen, sympathise, don't justify, make notes, agree a course of action and follow through?"

Can we do that? No!

What about:

"... if there's a wrong say so, explain truthfully, fix it and demonstrate we've learned, say sorry and mean it..."

Can we do that? No...

Why? The system doesn't allow that...

...so fix the system.

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