15/04/2010 by Patrick Keady.

HSJ reported today that there is lack of information on the safety and effectiveness of much NHS care and that this has been spelled out in an interim report from members of the NHS National Quality Board.

One of the NHSs prevailing beliefs seems to be, that individuals will perform better and their organisations will flourish …. when we reward the behaviours that we seek … and punish the behaviours that we dislike. This approach works well for simple, routine, rule-based work.

But NHS workers undertake other types of work, where non-routine creative and conceptual capabilities are also required.

I believe that Quality in the NHS will improve significantly when PCTs and Trusts demonstrate to their staff, that they understand what it is that really motivates their employees - the motivation of making progress in their work, improving quality and the simple satisfaction of getting better at what matters.

We know that businesses with transcendent purposes survive and continue to deliver excellent services to their customers. Too bad that ICI, Boeing and some of the large banks focussed too much on targets, and too little on purpose.

NHS targets are good. They continue to challenge clinical teams and Trusts. They have played a key role in improving the NHS. But more and more we are seeing that targets, potent as they are, can be an insufficient impetus for NHS staff and organisations. They do not get everyone leaping out of bed in the morning and racing to the wards, patients homes, theatres and meetings …. to do deliver excellent patient care.

The BBC’s Panorama team discovered earlier this year, that Trusts were incorrectly assessing performance, potentially distorting their standing in the CQC’s Annual Health Check. 17 out of the 28 Trusts visited by the CQC in 2009, made incorrect assessments. Did Mid-Staffs and Maidstone & Tunbridge Wells focus too much on targets, and too little on purpose?

While much has been written on aspects of Quality in the NHS, I would like the outputs from the NHS Quality Board to be short and to the point. To focus on Quality outcomes from the perspectives of the Treasury/National Insurance contributors, patients and employees.

And while the NHS focuses on purpose, that its satisfied employees will be racing to the wards, peoples homes, theatres and meetings …. to continue doing what motivates them best - making progress in their work, improving quality and the simple satisfaction of getting better at what matters.

About Patrick Keady

Patrick helps NHS organisations make better decisions. A former NHS Director of Governance and Strategy, he received awards from the BMA and IOSH. Patrick is a Company Director, a Trustee at a Chartered professional body and Editorial Board member at a peer-reviewed Journal. For more information, click www.betteroutcomes.org

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19/01/2010 by Patrick Keady.

HSJs Fundamentals of Governance took place in London, late last year.

Click here to see my review of the Conference. For a .pdf, contact me via www.betteroutcomes.org

About Patrick Keady

Patrick helps NHS organisations make better decisions. A former NHS Director of Governance and Strategy, he received awards from the BMA and IOSH. Patrick is a Company Director, a Trustee at a Chartered professional body and Editorial Board member at a peer-reviewed Journal. For more information, click www.betteroutcomes.org

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21/12/2009 by Patrick Keady.

Every week, I receive two or three phonecalls about assignments in NHS risk management, governance and safety. However, many of the proposed assignments would be a waste of NHS time and NHS money.

Earlier this year, a PCT asked me to lead on corporate governance, health & safety, risk management, information management, health records, complaints, claims, moving and handling and commissioning strategy.

I challenged the potential client to describe in a few short sentences, what they wanted me to achieve, and by when. They were unable to see or tell me what success might look like.

So, I offered them telephone coaching, free-of-charge. The PCT soon saw that my input would be very worthwhile in one discreet project, where my independent insight and skill-set was just right.

The project is mission-critical to the PCT. They were happy with my daily rates too ! And during the course of the phone conversations, the potential client identified in-house people that could lead on many of the other pieces of work.

NHS organisations need to clearly think about what they want to achieve, before contacting independent consultants.

About Patrick Keady

Patrick helps NHS organisations make better decisions. A former NHS Director of Governance and Strategy, he received awards from the BMA and IOSH. Patrick is a Company Director, a Trustee at a Chartered professional body and Editorial Board member at a peer-reviewed Journal. For more information, click www.betteroutcomes.org

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02/12/2009 by Patrick Keady.

Stephen Ramsden achieved so much at his NHS Foundation Trust. Just six weeks ago, the CQC rated Luton and Dunstable as the best acute trust in NHS East of England. HSJ reported today that he will be leaving the trust in the spring of 2010 after 12 years in the post.

And with 12 years as Chief Executive at his FT, he is a shining NHS example of what makes successful organisations …………successful.

Led by Jeff Immelt, CEO at General Electric, a study found one key trait that is common in all successful companies. Their managers stay in place for along time.

Staying in place for along time, gives them space to extend their abilities, to learn much more about their organisation, to develop the critical connections that make their organisations perform better.

This is what Stephen Ramsden did, as a Chief Executive at Luton and Dunstable. Medical staff become successful because they take similar speciality-specific steps to extend their abilities, to learn about their speciality and to develop critical connections.

Immelt also found the converse, asserting that ‘the places where we’ve churned people like reinsurance, are the places where you will find we’ve failed’. We’ve had examples in the NHS where people are ‘churned like reinsurance’.

We need more Stephen Ramsdens, not less!. And in turn, they need the support of their Boards, their employees, SHAs, Monitor, Governors and other key stakeholders.

Chief Executives need the time and space to get to know their organisations much better, to extent their personal abilities, to develop critical connections, to understand risks and how to manage them effectively.

And in return they will be better placed to ensure that their NHS organisations wrestle with the very real risks of escalating demand and constraining resources.

About Patrick Keady

Patrick helps NHS organisations make better decisions. A former NHS Director of Governance and Strategy, he received awards from the BMA and IOSH. Patrick is a Company Director, a Trustee at a Chartered professional body and Editorial Board member at a peer-reviewed Journal. For more information, click www.betteroutcomes.org

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17/07/2009 by Patrick Keady.

Listening to Evan Davis on BBC Radio 4, I was particularly interested in the language of his guests.

James Dyson introduced himself as the founder of vacuum cleaners that work better.

Marta Lane Fox, recently appointed Champion of Digital Inclusion, is working to make life better for the six million economically and socially disadvantaged people in the UK that have no access to technology.

And Adrian Ringrose  the chief executive of a company that enables public sector organisations do what they do, by doing all the bits that these organisations don’t want to think about.

When introducing ourselves in the NHS, we tend to use different language. And this episode of BBC Radio 4’s The Bottom Line promised a lot. It was a discussion about creativity and innovation.

To be good at innovation and creativity, Martha Lane Fox said that boldness and self-confidence works for her. James Dyson added that innovation for him is caring about solving problems and taking little incremental steps to get there.

And Adrian Ringrose gave his insight into the public sector. He suggested that it is more important to do what we do in the public sector - by the rules, rather than focusing on the end game.

A generalisation perhaps, he reminded us that it is the end point that matters and we are more likely to get there by building on our mistakes.

And my guess is that this point resonates with you and many leaders in NHS risk management, governance and safety. I enjoyed this edition of BBC Radio 4’s The Bottom Line and I know that you will too.

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31/03/2009 by Patrick Keady.

The NHS Institute has been an exciting place to work. During my 18 months with them, I led the development of their intranet-based risk register and board assurance framework, standing orders, standing financial instructions and scheme of delegation.

As well as being a key link between the Institute and the Department of Health, I was actively involved in developing their balanced scorecard; sustainable development; reviewing the security of their people, buildings and information; the procurement of health and safety training and risk assessment services and lots more besides.

Working with the NHS Institute meant a lot me. Over the 18 months, it has transformed into an outward looking, customer-focussed organisation. Whenever I hear about NHS Live, Knowledge Management, World Class Commissioning, the Management Training Schemes, the Productives, Safer Care series … I’ll think of them.

And I’m looking forward to my next assignment at NHS Stoke on Trent.

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12/02/2009 by Patrick Keady.

‘Without a national study, politicians and health professionals go into denial ….. we don’t have a problem’. This was one of the comments for Sir Liam Donaldson when he opened the Patient Safety Research Portfolio Conference this morning at the Royal College of Physicians

Speaking to a selection of the researchers that participated in the 36 patient safety research projects undertaken over seven years, at a cost of about 70p per NHS England employee per annum. He outlined his vision of the ten contributions that patient safety research offers to improving healthcare, as follows:

•    increasing awareness of patient safety - with clinicians, provider organisations and commissioners
•    understanding the causes of patient (un)safe-ty – and in relation to sleep deprivation, Sir Liam reminded us of the importance of the 48 hour week - clinicians are more likely to kill patients when they are tired.
•    more research in the young discipline of patient safety will enhance safety and improve productivity
•    establishing conceptual concepts - to enhance the ‘poverty of concepts in patient safety’
•    developing solutions – including improved design in healthcare, a recurring theme throughout the day
•    setting standards for information – before and after studies, randomised control trials etc
•    informing evidence based care
•    evaluating progress including checklists - twice as effective as education
•    nurturing researchers
•    and promoting leaders in patient safety

Professor Richard Lilford oversaw the Patient Safety Research Portfolio from its inception and this morning, he highlighted some of the successes of the programme. These included Professor Nick Barber’s discovery that nursing homes openly welcomed the prospect of his team observing medication errors and recommending improvements – their willingness could be related to the significant amount of time that care home staff spend in medication-related activities.

The day was chaired by Professor Paul Barach, one of the best Chairs that I’ve seen at a healthcare seminar/conference. He has has a very rare ability. He keeps the audience interested, even during the ‘graveyard shift’.  And he ensured that all 17 leaders in patient safety research, delivered their presentations in less than 4 hours. Now that is a rare achievement.

Citing an (unnamed) study elsewhere in the world, we heard that 9% of clinicians wash their hands before they touch a patient in the operating room and 17% do so after they touch the patient. Enter Professor Sheldon Stone summarising the successes of the Clean Your Hands campaign – and reminding us of the rationale for the campaign - 8% of patients acquire healthcare associated infections and their mortality is six times higher. Direct contact by hand is the main route of infection and Sheldon delivered this very serious message, in an entertaining way.

Chris Fuller described HHOT – the hand hygiene observation tool and Professor George Hanna told us about the checking procedures developed by his team for naso-gastric tubes. Dr Rebecca Lawton highlighted the success and lessons learned in evaluating non-luer spinal connectors.

While risk metrices represent risk and are almost universal in healthcare, Professor John Clarkson highlighted their limitations - they lack a systematic approach. And this is why he and his team are developing a toolbox for healthcare, that will include risk assessment models and tools and a process for escalating the higher risks.

Dr Karin Lowson’s insight into single hospital rooms, was topical and revealing. Patients in single rooms are more satisfied. They are less likely to acquire infection experience medication errors during their hospital stay. That said, some patient in single rooms are more likely to die and experience depression. And the risk of an adverse event and length of stay are about the same for patients in wards and in single rooms.

Much has been said about enhancing the patient safety agenda on the curricula of healthcare professionals. And recommendations as to this an be achieved, were provided by Dr Pauline Pearson and Professor Amanda Howe.

Professor Ian Watt gave an overview of how patients can ensire that clinicians deliver safe patient care – by making sure that the treatment is appropriate for them, that the treatment is as planned and in accordance with the appropriate protocol, and identifying how the health system can be made safer.

Dr Ken Catchpole shared his line of enquiry in operating theatres and elsewhere in healthcare. And he has four key questions. Is the healthcare team’s approach consistent with achieving high standards of care. Is what they are doing acceptable for Ken and his family. Does what the team are doing have to be like this. Is this the best it can be? Simple questions, revealing answers.

And Professor Mary Dixon-Woods outlined six rules for governance in operating theatres. The organisation is geared to promote patient safety. Protocols are deployed appropriately and everyone serves their spirit. Optimum communication. Minimal distraction and interruption. Effective authority and accountability. Reporting patient safety incidents.

Professor Justin Waring is in the process of summarising the outputs from the PSRP under the broad headings of the nature of patient safety, sources of risk and safety, and identifying the future direction for research.

And Martin Fletcher was the final speaker, talking about the science of safety. The NPSA Chief Executive sees the patient safety research agenda developing by networking the researchers, funding more PhD students and running another UK patient safety research conference.
Some of the many highlights for me were hearing about the science of safety, Ken Catchpole’s approach to enquiry in patient safety, how patients can be more assertive, updating the curricula, design of hospitals and non-luer spinal connectors, prospective analysis, competency based training in naso-gastric tubes and handwashing, observing hand hygiene, the benefits and weaknesses of focusing on improving culture and CHUMS.

With many thanks to Sir Liam Donaldson, Professor Lilford, the PSRP team and all of the researchers for making this fantastic conference a reality.

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21/11/2008 by Patrick Keady.

While it seems obvious now, I’d never thought about equality and diversity like this before. Today I learned that equality and diversity affects all of us. Whether its because of gender, race, sexual orientation, bullying, home circumstances, nationality, disability, harassment, age, sickness absence etc.

Run by the Garnett Foundation, today’s session was all about exploring equality and diversity in relation to recruitment and selection. Using a range of interactive approaches, we practised and developed our interviewing skills. While professional actors played a number of diverse parts.

During lively interactive workshops, we explored staff retention and working cultures that foster inclusion and diversity. The training event provided a safe learning environment to highlight areas for improvement in our knowledge and understanding and also to share learning.
While I had heard a lot about the Garnett Foundation,  today’s training session met my expectations, and more.

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15/10/2008 by Patrick Keady.

I chaired NHS Risk Management today. Organised by the Health Service Journal, NHS Risk Management was their first conference that focussed exclusively on risk management.

Birmingham’s Centennial Centre was oozing with energy and attendees including clinical governance managers (10%), safety and health practitioners (15%), risk managers (35%) and directors (40%). And the delegates came from the full spectrum of healthcare organisations: SHA/other (5%), Foundation Trusts (10%), Independent Healthcare (20%), Trusts (30%) and PCTs (35%).

While I’ve been practicing in risk management for 20 years, I had mixed expectations of the conference …… and thankfully it was an enjoyable and informative conference. Here were some of the highlights for me.

Mark Burns, the Safety and Security Adviser at Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust reminded us of how risk management is now directly linked with Corporate Objectives. Trusts are more aware of their risk appetite - the level of risk that they are happy with. And he reflected on how reactions to incidents have improved – senior managers today ask ‘what happened?’ In the past, they would have asked ‘who did it?’

Linda Handley-Wright, the Risk Manager at Derby City PCT expanded on the theme of culture. The key is to make risk management interesting, using LEAN principles and engaging the right people. Linda added that organisations need to address different learning styles – including scenarios, what if’s and linking risk management with other initiatives via training needs analysis. In Derby, they’ve taken Standards for Better Health as the basis of something much better - they’ve produced the Healthy Derby 10-year plan aimed at improving health, commissioning and engagement.

And engagement was a key message from Dr Anne Dyas, a Consultant Microbiologist at Worcestershire Acute Hospitals NHS Trust. Dr Dyas urged that ‘we (people involved in managing risks) must get out there and teach. To be prepared to defend changes in practice with robust evidence’. She warned that changes introduced simply for public relations reasons will not be sustainable. Jobs done in haste will probably be done badly. Dr Dyas added that data is only as good as those that gather it – she warned against multiple data sources. Most extra tasks need extra hands and extra equipment. New initiatives must support the task (of infection prevention and control) and not add to it. And do Dr Dyas’s views work in practice? Definately. Dr Dyas’s team oversaw a significant reduction in MRSA and CDiff at their Trust and this helped them win the 2008 Oxoid Infection Control Team Award.

Anne Cleminson (Trust Secretary) and Steve Bradbury (Risk Manager) from Mersey Care NHS Trust described the key elements of Assurance at their Trust - getting buy-in from key stakeholders, Committees that are fit-for-purpose, an effective Assurance Framework and good communication. And the Trust’s biggest champions are the Non-Executive Directors because of their creativity and innovation.

Ian Strudley, Head of the Health and Social Care Services, Health and Safety Executive, reminded delegates that HSE is all about reducing the real risks – upto 250 people die every year at work in the UK and many more have serious injuries and ill health. HSE reduces the real risks, by balancing risks and benefits. He gave examples of how HSE is working in partnership with organisations such as the Healthcare Commission – agreeing the Concordat for joint working between regulatory and inspecting bodies. HSE works with the NHS Litigation Authority – workshops on stress management standards. And with respect to managing violence and aggression, it works with the NHS Counter Fraud and Security Management Service.

Stephen Williamson, the Corporate Health, Safety and Risk Adviser at University Hospital of South Manchester NHS Foundation Trust reminded us of what the ideal health and safety management system looks like - setting the policy, organizing, planning for action, measuring performance, auditing compliance and review. Steve reflected the views of many delegates with respect to NHS Patient Safety First – that it will succeed with Executive ownership, and clear commitment from clinicians, managers, corporate and support functions.

Gary Hay and David Firth, partners at Capsticks, gave an overview of key legal compliance and regulation. They described the risk-related legislation in place, CNST claims, the NHSLA risk management standards, employment legislation and stress at work. No real surprises there. And then they introduced a case-study about a patient scalded in a bath – and delegates faces lit up. The case study renewed the energy of the audience. The case study felt real and it gave the delegates and opportunity to contribute.

And then the controversial (and most thought-provoking) presentation – on World Class Commissioning. Controversial because it was close to home for many of the delegates. Roger Hymas from Humana, had recently completed a secondment as Director of Commissioning with Hampshire PCT. And he reminded us that on 4th July, the Financial Times proposed that the PCTs be turned into one giant health insurer. Roger highlighted eight ‘tests’ for insurers – and PCTs meet three of the tests, don’t meet another three and possibly meet the remaining two.

Roger identified his top-10 risks facing the NHS. And in reverse order they were:

10. The NHS will run out of money in the longterm, and not before the next general election (possibly June 2010). 2008 is the year when demand is running ahead of budgets and at the same time, PCTs are spending just 15% of what the private sector spends on managing Commissioning – the suggestion here is that PCT Commissioning functions need to be better funded and by implication, they need a greater range of skills in their teams.

9. Practice-based commissioning will not gain traction. While it is estimated that only a third of GPs will be willing and able to make practice-based commissioning deliver in the way that PBC advocates suggest, by increasing PBC activity, the NHS has the potential to redistribute significant amounts of money – with GPs switching patients from one Acute Trust to another.

8. Block contracts remain impenetrable to PCT scrutiny and validation, including mental health block contracts - see Risk 10 above about PCT Commissioning functions.

7. PCTs need to invest more in management systems. In other words if PCTS don’t put aside money to invest in management systems, they’re unlikely to get control of their PCT finances – links with Risk 10 !

6. The supply side will shrink - reducing competition and choice. This will be a consequence of Trust mergers and some of the private sector providers (including ISTCs) retreating from NHS provison

5. Patients need more encouragement to play their role in re-shaping the market. Consumer surveys consistently show that consumers want choice. Patient Choice has much more to do, if it is to achieve its potential.

4,3 and 2 - Is Monitor encouraging Foundation Trusts to be too aggressive in developing their financial strategies (?) through:
- the pursuit of earnings before interest, tax, depreciation and amortisation as a key measure of success.
- the building of significant capital reserves on FT balance sheets
- service line analysis which could lead to huge distortions in provision

PCTs that transfer money to their local FT and other providers are transferring the financial risk to themselves! They are also in danger of losing control of Commissioning. Armed with the management tools developed by Monitor, FTs may choose to cherry-pick the more financially profitable specialties and procedures. And FTs could choose to unilaterally decommission services, putting patients at risk.

1. WCC will not move fast enough - or fail.

What a thought-provoking presentation to end the day. And it suggests that provided PCTs implement robust risk management processes and they invest in management systems, then World Class Commissioning is likely to become a reality.

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23/09/2008 by Patrick Keady.

With Dr Hassan Khimji and Professor Chitta Choudhury at the RSPH launch.

I was invited to the launch of the Royal Society for Public Health this afternoon. This new Royal Society is dedicated to the promotion and protection of collective human health and wellbeing. It will advise on policy development, provide education and training services, encourage scientific research, disseminate information and certify products, training centres and processes.

Professor Alan Maryon-Davis in the inaugural chair and the chair elect from April 2009 is Dr Selwyn Hodge. Professor Richard Parish is the chief executive.

Held at the Royal College of Obstetricians and Gynaecologists, many key leaders participated, including:

-    Dame Suzi Leather, chair of the Charity Commission
-    Sir Derek Wanless, author of Securing our Future Health (2002) and Our Future Health Secured? (2007)
-    Sir Ronald De Witt, chief executive of Her Majesty’s Courts Service and executive director of the Department of Constitutional Affairs corporate board
-    Professor Mala Rao, RSPH Ambassador to India
-    Dr Fiona Adshead, Deputy Chief Medical Officer
-    Dr Linda Degutis, president, American Public Health Association
-    Dr Georges Benjamin, chief executive, American Public Health Association

Hazel Stuteley OBE introduced herself as a ‘Sir Derek Groupie’, resulting in the first of many laughs during her presentation. And between the jokes, Hazel gave us a number of very serious messages. She reminded us of the famous Mary Mead quotation, ‘never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it’s the only thing that ever has’.

Hazel told us of how a small group of thoughtful committed citizens in England’s poorest County (Cornwall) did just that ……. in Falmouth. In a true example of multiagency working (health, police, education), significant reductions were achieved in asthma, teenage pregnancies and postnatal depression. There were big improvements in child protection. This and much more was achieved with excellent value for money too – less than 50 pence a day, for each resident.

The Royal Society for Public Health is the result of a merger between the Royal Society of Health and the Royal Institute of Public Health. Membership of the new Royal Society includes professionals from health protection, environmental health, the health professions including medicine, health & safety, food hygiene, nutrition, health promotion, teaching, research, social care and more.

Click here and here for more details of the launch

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