Boards do not need to wait for Francis

As we wait for the second Francis report, the question has to be asked, given we already know much of what is needed to drive improvements, why are so many healthcare providers waiting?

Certainly regulators and legislators need to wait for the detail of Francis II, but boards and leaders of healthcare providers should be acting now.

Will the upshot of the Francis report mean better regulation – or just more regulation? More regulation sometimes runs the risk of increasing constraints on people using their judgement on how care can be improved.

Regardless of the regulatory obligations which exist, boards have a responsibility for ensuring that the organisation doesn’t become disproportionately focused on meeting those requirements. Where a board fails to do this, there is a danger that the real purpose and values of the organisation – to provide care which is patient centred, safe and delivered with compassion – become “squeezed out” by a focus on “survival” and regulatory compliance.

But this will be part of a greater cultural change that trust boards need to spearhead, making sure that the purpose of the organisation and the aims and incentives of the staff are aligned.

Boards should be aware of their critical role in influencing and shaping an organisational culture in which the care of each patient is at the centre of decision making at all levels. Boards should try to:

• Humanise decisions by looking at the ethical dimensions – are all decisions the board makes explicitly evaluated against the impact that it will have on patients?
• Build the capacity of non-executive directors to fulfil their role of challenging the organisation, and identifying where executive decision making may be conflicted between survival or compliance, and patient interest.
• Recognise and celebrate people for doing the right thing, not just for meeting targets or budgets. 

Above all, boards need to remember that how they behave impacts on patients on the front line. Boards, and especially non-executive directors, should be confident in their answers to each of these questions:

• Are the behaviours exhibited by the leaders in your organisation, and the way you treat staff, 100 per cent consistent with the organisation’s professed values?
• When employees read your annual report, do they see a trust they recognise?
• What aspects of your trust would you worry about being on the front pages of the newspaper?
• Would you feel completely happy if an elderly member of your family was admitted to your hospital as an emergency over the weekend?

Any hesitation means boards need to act now, and not wait for the next inquiry or recommendation.

Sally Bassett is a director and Janet Dawson is healthcare lead partner at PwC