24th February 2016

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Prof Sir Mike (Deep-Diver) Richards - CQC
In conversation with Roy Lilley - King's Fund March 1st, 5.30pm
Sold Out  HERE

News and Comment from Roy Lilley
The King's Fund is having another go at quality.  They've shipped in Don Berwick to give a gloss on what is a pretty mundane report
Mundane?  Probably the wrong word.  Predictable?  Maybe?  Expected, foreseeable, anticipated, routine?  Any of those will do.  Nothing new in it.
By the way, not wishing to be churlish but what happened to the last report that had Berwick's name on it?  #justasking.
Since Edwards Deming gave us 14 simple reference points, Phil Crosby pointed out that Quality is Free and Tom Peters electrified management with his book In Search of Excellence a slew of gurus have repackaged, peddled, dressed up and polished the same messages to build careers and managers 'with stinkin' thinkin' have misrepresented the ideas, turning them into stick to beat people with.
There are probably only a handful of fundamental truths about quality.
Quality is what we do when no one is watching.  We do good stuff because we care about what we do.  We do good stuff because we know what good looks like and want to do it... better.  We do good stuff because someone bright has created the time and space for good people to do great things. 
When we don't do good stuff it's because we don't know how to do what we do, better.  That is why sharing, transparency and making it ok-to-ask is so important.  We have to know where to look.  

We don't do good stuff because our inspiration, energy and enthusiasm is drained from us by impossible demands; getting through the day becomes good enough.
When quality doesn't happen we must stop asking 'who did this' and start asking 'why did this happen'.  We need a mature understanding of the causes of failure and our attitude to it.  The NHS is high risk and failures will happen.  Figuring out why something went wrong is the only worthwhile activity because once you know...  you can make sure it doesn't happen again.
Protect the front-line, fund it properly and make it fun to work there; fighting with your staff is a bad idea; the junior doctor's spat is a stupid sideshow and distracting, impeding quality and delivery.  The proposed contract is as complicated as the last one.  Berwick is right; say sorry, start again. 

Variation is the enemy of quality - finding out what we are doing; deciding if it's what we want, put things in place to make sure we get them all the time, every time... until we don't want them any more.  Quality is simple.
We can inspect until hell freezes over but it won't improve quality.  The NHS has 'inspected' in one way or another, for 17 years and spent the best part of 1,360,000,000; two thirds of our Trusts still have 'quality issues'.  Quality is not about inspection it is about reflection.  Reflecting on what we do, when and where we do it and can we do it better.
Berwick doesn't do austerity.  He says; there is no Western democracy that spends less than 8% GDP on healthcare and expects to meet public expectations of healthcare. 

Sorry Don, you may not but we have to.
We are pretty much at the -8% and polling would seem to indicate that whilst the NHS is increasingly rough around the edges, patient satisfaction remains high enough not frighten politicians or the Treasury into more money. 
Indeed, listen to Lord Carter (and they do) and you'd expect any increase in funding to be a luxury.  He says there is +5bn that can be plucked and saved, for the asking.  

Maybe Crosby is right, quality is free... it's attitudes that cost us.
My cynicism about another report on quality is founded on a raging frustration that culminated, last year, in us investing in the Academy of Fabulous Stuff.  I really do believe; show people what good looks like and they will want to do it... better.  Share good ideas and you will get more good ideas.  
A free repository to share best practice for everything from end of life care to flow calculations in A&E.  Medicines management to making cakes for a dementia party.  Computer modelling for commissioning decisions and revalidation templates.
So far half a million pages have been shared; every day 1,200 people search the Academy site for knowledge or inspiration.  Including a well know US hospital chain...
Reports that are full of 'we should' and 'we must' leave me cold.  I prefer 'here's how'.  The King's Fund's 'how', to be add to the coral reef of lost ideas, is a National Centre for Quality Improvement. 
No, no, no.  Anything with national in the title is doomed... when will they learn! 
The NHS front-line is already doing transformation, transparency, sharing and getting on with it without the DH, NHSE, Not-Monitor, think-tanks, ministers or managers and it is fabulous.
Have you looked at the fabulous stuff?
New 'shares' every day.
Make a note; be a sharer this week
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In conversatin with Roy Lilley
King's Fund 
14th April
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