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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12/11/2009 by Patrick Keady.

One of the headlines on www.hsj.co.uk today, caught my eye. Managers anger at O’Brien’s name and shame threat.  And then it began to make sense. Mike O’Brien and David Nicholson seem to be speaking the same language!

In each year since 2000, Mike O’Brien and his colleagues in the Blair/Brown Governments, increased their funding of the NHS in England by almost 7% (on average).

And now we are preparing for annual funding increases that will be much closer to 0%. David Nicholson told us earlier this year that the NHS needs to find £15bn-£20bn of savings by 2014. The NHS has two options.

The first is to hit the target and miss the point.

By reducing inputs - cutting staff, closing buildings and increasing waiting lists. Its refreshing that Mike O’Brien does not want to see budgets and services slashed in response to the public sector funding squeeze.

Hitting the target and missing the point would be costly. Patients would not be interested in why NHS services were being cut. They would not want explanations as to why there were less staff on-duty.

Patients expect a return on their investment - for the National Insurance Contributions that they have and/or are making. And my guess is that patients will continue to expect better healthcare.

The second option is to hit the target …. and to hit the point.

By reducing waste in core processes, such as diagnosing, treating, and communicating with patients. By getting the care of patients right first time. By reducing unnecessary readmissions.

By ensuring that clinicians and managers feel empowered to achieve results, to make changes, to take decisions, to drive service improvement, to actively deal with risk.

The NHS is likely to reduce waste in core processes, when Directors of Finance and their colleagues become even more actively involved in process improvement and removing waste. When they continue allocating serious investment in the development of improvement capability. By continuing to focus on cost per unit, and not expecting increased funding from the Government or elsewhere.

My guess is that Mike O’Brien will not ‘name and shame’. Because the NHS will actively work to reduce waste in its core processes. And that the NHS will find the £15-£20bn of savings by 2014. And because Mike O’Brien and David Nicholson will continue to speak the same language.

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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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