Looking back on my blogs, I’ve often revisited some fundamental issues because I think they are utterly vital in the debate about healthcare and our place within it. You will have heard me talk a lot about clinical quality being the only game in town and how this is manifested through the Granny Test. Essentially this means that if the care we provide would not be good enough for a member of our family, we have no right to inflict it on someone else’s family member. I’ve also blogged a lot about our values and how we embody them as an organisation. One of the most disturbing things I’ve seen in my career, is healthcare getting more and more complicated and the system becoming increasingly complex, to the point where our compassion and original motivation for pursuing healthcare as a career is squeezed out of us. With both of these issues in mind, I today want to reflect on two pretty important cases that have been heavily publicized recently. Although they’ve happened on different sides of the world, you’ll see that they both speak to global issues in healthcare – our values, our compassion and how we ensure that the care we provide continues to be of the highest quality.
The first case involves Stafford Hospital, which is managed by the Mid Staffordshire NHS Foundation Trust in the UK. Many of you will be aware of this story which saw staff at Stafford Hospital, from the Chief Executive and Board right down to the clinical staff, become so absorbed in delivering targets and ‘looking good’ that basic standards of care and compassion for patients were lost. As a result, up 1200 patients died needlessly through the most appalling neglect over the course of three or four years. For those who want to read more about it, you can view the recently released report here.
For me, this story speaks to organisational culture and the tragic outcomes that can, and sadly do, happen when an organisation loses what I would describe as its moral compass. I find it astonishing that a hospital can so lose the plot that it tolerated and ignored appalling standards of care over such a long period of time. It is devastating that nobody was prepared to speak out, or that their complaints fell on deaf ears, for years on end.
The second case involves the tragic loss of a medical student who died of meningitis at Auckland City Hospital in 2009. The Coroner originally suppressed the names of the four healthcare workers involved in the case because he found that the system, rather than any individual(s), was at fault. As you may be aware, this was recently overturned by the High Court, which ruled that the principles of freedom of expression and open justice outweighed the grounds of suppression put forward by the Coroner.
I don’t wish to comment on the legal arguments of this case, however I do feel it introduces a considerable challenge to healthcare – how do we ensure that we have a culture in which we can admit our mistakes and improve without those involved feeling unfairly threatened or fearful of recriminations? This case may well cause healthcare workers to feel rightly nervous about being open and honest about errors, which is the point at which we are in danger of losing our moral compass, as happened at Stafford Hospital.
I’d like to remind you all of the blog post Dr Mary Seddon and I wrote in November 2011 on CMDHB’s Attitude to Errors and reassure you that our approach has not changed. We are committed to fostering a ‘Just Culture’, meaning that we have an expectation of high quality individual performance but open disclosure should an error occur. We are also committed to creating an environment of openness, honesty and support for staff to raise concerns, report mistakes and challenge the way we work. We know that most mistakes are the result of the system. Healthcare is now so complicated that very rarely do mistakes happen as the result of a single practitioner inadvertently doing something wrong. In the understandable need to find who or what is to blame for an unnecessary death, we need to be mindful of this fact. It would be a real tragedy if we lost our ability to be open and honest about the work that we do.
When I talk at the Welcome Day induction for new staff, I always mention the Granny Test because I think the decision whether or not to recommend our hospital to our friends and family is a very good litmus test for what we really think. I also always say that the person who must be challenged the most in this organisation is the Chief Executive and I really hold true to that. I work for this organisation and for you, not the other way around. One of the most important things I can do to make that a positive reality is to maintain an atmosphere where people are able to speak out openly, debate issues and feel safe in suggesting how we can improve.
Like you, I want CM Health to be a successful organisation and I’m certainly very proud of our history of hitting health targets. But we hit our health targets as a result of good quality, not the other way around. This is a critical distinction for me – I don’t want to hit the target but miss the point. And the point is ensuring that we work together openly and honestly to provide the highest quality care possible. To quote Health Quality and Safety Commission Chair, Professor Alan Merry, “the task is not to apportion blame but about improving the quality and safety of our services”.
I hope you enjoyed the Easter break with your whaanau and friends.