Thursday, 12 December 2013

The NHS needs to welcome complaints and staff who raise concerns

The NHS needs to welcome complaints and staff who raise concerns When warning signs are ignored, minor problems can turn into crises.

Complaints and compliments should be key drivers of reform in any NHS organisation. Services constantly alert to the experiences and views of their patients and staff will spot problems early, respond quickly and effectively, and welcome rather than resent criticism.
When warning signs are ignored or not pursued, small difficulties will develop into crises. In the review by NHS England medical director Sir Bruce Keogh of the care provided by 14 trusts with high mortality rates, being slow to learn lessons when things went wrong and failing to drive change through the system were among the faults he identified.
When staff did raise concerns they often did not know if anyone had taken action, and in some cases they felt uncomfortable about approaching managers.
The listening culture starts at the top. In hospital trusts, the board's awareness of complaints, and the use to which it puts them, is a powerful indicator of their engagement with patients and their understanding of how good or bad their services really are.
In the wake of the Francis inquiry, there was a widespread realisation that many boards were obsessing about finance while relegating issues around the quality of care to the end of their meetings.
Now, it is common for board meetings to begin with a patient story. While this at least serves to remind directors why they are ultimately there, if it does not lead to action, it is nothing more than a gesture.
The best boards ensure complaints are analysed to reveal the underlying weaknesses in the system, then work with managers and senior clinicians to ensure changes are identified and driven right the way through the trust.
Faced with a growing battery of regulation, and the bizarre recent phenomenon of health secretary Jeremy Hunt personally phoning trust chief executives to pressurise them to sort out A&E problems, it is terrifyingly easy for boards and senior managers to respond to problems with blame and aggression – the infamous NHS bullying culture that has to be eradicated.
Whatever the outside pressures, inside the organisation leaders need to create a trusting and supportive environment which welcomes, and indeed celebrates, staff who raise concerns. The first reaction is to learn lessons and secure changes rather than find someone to blame.
Junior doctors are a group of staff whose insights are routinely undervalued. For example, they regularly undertake audits as part of their training, but the information they gather is rarely used to secure improvements.
Highly trained, ambitious and often new to that particular department, they are ideally placed to see a service afresh. But this only works, of course, if consultants are willing to consider their observations and ideas. The record can best be described as patchy.
Leadership training programmes for junior doctors are growing, but much more should be done.
As it is now open season on NHS failures, it is easy to forget that it is not just problems that should be driving change. While the health service is getting better at celebrating staff achievements, it is less good at identifying why things are going right and spreading that through the organisation.
Improving integration between services is an obvious example of where patient insights can drive change. If someone writes to tell you that their hospital care was seamlessly co-ordinated with social services support and a home visit from their GP, it might be as well to investigate how all that happened and make sure it happens again.
NHS services which welcome complaints, discuss them with an open mind and embrace them as an opportunity to secure a better experience for patients are likely to be confident, trusting organisations that value their staff and patients.
Ultimately it is about distributing power – enabling those who both give and receive care to make the system better.
Richard Vize is a trustee of the whistleblowing charity Public Concern at Work Guardian Professional.

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