Mid Staffs not only ‘dark spot’ in NHS
pharmafile | September 10, 2013 | News story | Medical Communications, Sales and Marketing | BMJ, Mid Staffs, NHS
The scandal of poor patient care at the Mid Staffordshire NHS Foundation Trust is likely to be far from an isolated example of bad practice, according to a new report.
The Health and Safety Executive has already announced it is to bring criminal charges against Mid Staffs, but the findings of a new survey of NHS activity suggest that this will be far from the end of the matter.
“Though Mid Staffordshire may have been one particularly ‘dark spot’ in the NHS, organisations throughout the NHS are likely to have at least some shadows,” write the authors of ‘Culture and behaviour in the English NHS’, which has been published in BMJ Quality & Safety.
Their analysis showed “there was little confidence that care could be relied on to be good at all times in all parts of organisations”.
Opaque goals, an excessive culture of box ticking and regulation, as well as variable staff support are among the key problems “stifling the almost universal desire to provide high quality care”, the report suggests.
It was put together following two years of research, starting in 2010 after the first inquiry into Mid Staffs, and going up to the adoption into law of the Health and Social Care Act in 2012.
This included 300 interviews with senior NHS executives, managers and staff, plus analysis of patient and carer surveys, board minutes and published data on performance in all types of NHS trust.
It also looked at ethnographic case studies of hospital wards, primary care practices and emergency care departments – 650 hours of observation in all.
The researchers found that unclear or disjointed goals led to ‘priority thickets’ which swallow resources but give little clarity or coherence.
Moreover, having different regulatory bodies and other external agencies tends to lead to ‘ambiguity, fragmentation, and competing pressures’.
The study also identified ‘comfort-seeking behaviours’, which “focus on making a good external impression and view staff who raise concerns as trouble-makers and whiners”.
Finally, it said there was a problem with the use of quality improvement management techniques and a belief in ‘magical thinking’ – the belief that one initiative can solve many problems quickly and easily.
The authors make several recommendations, chiefly that NHS organisations must:
- be given “clear and explicit goals that are coherent from ward to Whitehall” – essential “to avoid dispersing responsibility and accountability, and creating confusing messages and signals”
- have good intelligence on their performance – which means “actively seeking uncomfortable and challenging information from patients and staff” and acting on it
- constantly review, strengthen, and improve systems, focussing on developing cultures that are person-centred rather than task-centred
- do more to ensure the engagement and health and wellbeing of their staff.
“Our research shows strong links between staff experience and patient mortality rates,” said Professor Michael West, who led the study. “Looking after patients requires looking after staff.”
Also, NHS England and clinical commissioning groups should not be given any further priorities – instead the emphasis should be on ‘ensuring focus and coherence’.
The report is far from damning, and says there are many examples of ‘exemplary and innovative care’ in public health and that more can be done.
“The NHS is far from unique in experiencing challenges,” concludes study author Professor Mary Dixon-Woods. “Every health system in the world is grappling with patient safety problems. But the NHS is uniquely well-placed to address them.”
Professor Don Berwick’s report into NHS patient care earlier this month emphasised that more needed to be done to help staff.
In July health secretary Jeremy Hunt announced that 11 hospitals in England were to be put into ‘special measures’ and are to be put under the microscope next year by the new chief inspector of hospitals, Professor Sir Mike Richards.
Adam Hill
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