Richard Pound
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Comments (6)
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Comment on: Getting clinicians to speak up is the real key to fighting poor care
I couldn't agree more with your points Alastair, and I believe that everyone would agree that in a 'perfect world' everyone would speak up when they see things they don't like or feel are detrimental to patient care. The question is therefore, how do we get people to speak up to break this culture of silence or culture of avoidance where we all collectively ignore issues? The answer is not a single silver bullet of more inspections, regulators or better data - it's a combination of factors that will influence people to change - factors that motivate and enable people to speak up. People need to be constantly personally motivated to speak up, they need to have the personal skills to speak up (not as easy as it sounds): People need the social support at all levels, so they feel able and encouraged to speak up; People need to know that the consequences of speaking up or 'whistle blowing' , is not going to lead to isolation or sidelining or worse - in fact we need to publically celebrate when people do speak up. Finally we need to create an environment that makes it easy for people to speak and remind them of the importance of this. Combining these '6 sources of influence' into a single influence strategy for change is the only way to get people to speak up. Very very few people come into work to harm patients and provide poor care, but we are blind and outnumbered by the various sources of influence that determine our behaviour - and stop us speaking up when we see things going wrong. If our sole weaponary to get people to speak up and improve care is 'regulation', we are failing to understand the complexities of human behaviour. We did some 'Silence KIlls' research with hundreds of NHS staff last year, and have shown that if we do use these 6 sources, you are 10 times more likely to get people to speak up. If anyone would like a copy of this research, please email me at richard@gra.uk.com Thanks Alastair for re-starting this debate, that is the key to improving patient care.
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Comment on: Change one thing
The one thing I'd change and influence is people's behaviour - which is only thing that will help improve patient safety. There will of course be many factors that drive human behaviour, but until we decide what behaviour we want to change, we will have no focus for our influence efforts. The key behaviour that will help with this is people's ability to speak up and challenge others when they see something wrong about to happen that will impact on patient safety. Unfortunately, despite out best intentions we are not always good a speaking up, and this 'culture of silence' is a major impact on patient safety. See www.silencekills.com for some recent research on this subject that I am aware of.
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Comment on: Risk management: create a culture of safety
Changing tack slightly, it's crucial to remember that Culture is just a collection of people's behaviour, and we'll only change the culture by influencing how people at all levels behave - staff, managers, and patients. Unfortunately, when it comes to influencing people's behaviour, we tend to jump straight to simple 'quick' fix management solutions (like new policies, training, new governance arrangements), and do not focus on ALL of the reasons that people aren't currently doing what we want them to. People behave in the way they do, because of their motivation and ability, and we need to split this across 3 domains - their Personal Motivation and Ability; the Social Motivation and Ability; and the Structural Motivation and Ability. All of these 6 areas will have an influence on my behaviour. We then should focus on developing influence strategies in each of these 6 areas for each key behaviour that we want people to do. For instance, the biggest behaviour that helps creates a culture of safety is open, honestly and candidly challenging others when you see something is wrong (or that maybe wrong), or somebody about to make a mistake (see www.silencekills.com). Rules, policies, H&S training and re-structuring don't change this behaviour on their own. The questions is then how to motivate and enable people to speak up in this way - and there are some simple and effective ways of doing this. This approach has been used by IHI in the US, and was a key factor in saving 100,000 lives in US hospitals in 18 months....contact me on richard@gra.uk.com if you want to know more.
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Comment on: Patient safety incidents up 12 per cent
I agree wholeheartedly with your comments Kenneth. I supprt this view, but also that this zero harm policy can only be implemeneted by thinking of all this in terms of changing and influencing people's behaviour - staff, patients, other stakeholders. It's only people's behaviour that is giving us these problem and statistics, and it's people's behavioiur that will fix it. The problem is we tend to focus on new rules, regulations, incentive and threats, and jump to the conclusion that a single solution will fix a very complex issue...and we do not look at the those key behavuiours that we want to change, and then focus on motivating and enabling people to do those new behaviours (or stop the bad behaviours). It's all about 'influence'..... Look at "Influencer: the Power to change anything" for more details or see www.gra.uk.com.
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Comment on: Clinical improvements could save NHS £9bn a year
It's good to have some focus for high impact cost savings, but there's a risk that this will simply lead to more targets, regulations and pressures on trusts that take the focus off patient care. We need to remember that all these cost savings will only be achieved by people behaving differently. At the end of the day, it is peoples' behaviour (staff, patients other stakeholders) that are giving us these problems (e.g. sickness absence, falls, malnutrition)....and it's only by influencing people to behave differently (and in a sustainable way) will we be able to deliver these results. Unfortunately I suspect that the next steps will be rules, regulation and demands - rather than spending time defining what key 'vital behaviours' need to be enacted by people to meet these targets - and then developing the various influence strategies to motivate and enable people to do those high leverage behaviours.
