The challenges facing the NHS mean organisations need to manage their reputation and relationship with patients to safeguard future services and funding. Ensuring stringent compliance measures are in place are a vital part of this process, writes Liz Jones.
As the government shakes up the health service and paves the way for a more competitive environment where success will be routed in quality, the NHS is under more pressure than ever to demonstrate that it can deliver continuously excellent patient care and outcomes while minimising clinical and operational risk and operating within budget. These challenges are compounded by government spending cuts and increasingly stringent regulatory compliance backed by legal redress.
In this climate, an organisation’s reputation is critical. The Care Quality Commission is now conducting more profound and frequent inspections with little notice. Hospitals have virtually no time to prepare and yet the outcomes from these inspections have a direct impact on a trust’s licence to operate and its reputation with patients, the public and commissioners.
Combined with NHS Litigation Authority inspections, whose verdict also provides a public assessment of the level of clinical risk at a trust impacting the price of its insurance premiums, trusts need to be certain they’ve taken every step possible to comply with regulations and reduce risk to its patients and future.
As the Department of Health introduces more competition and commissioning consortia bodies start scrutinising trusts, reviewing their record on outcomes in detail, hospital budget sheets and income will be determined by the strength of their reputation. In this environment, the patient dynamic is changing, and understandably so.
In fact, demonstrating continuously excellent patient care can seem almost impossible; given all that hospitals have to manage in a live and changing situation. Add to this the CQC’s increasing monitoring of social networking sites like Twitter for patient feedback and the growing number of Freedom of Information requests, whereby members of the public can demand evidence that certain recommendations have been followed through and acted upon, and it’s clear that trusts need to view compliance as a strategic imperative.
This fundamental shift in how a trust views compliance means regulation is less about passing the test and more about safeguarding quality, driving improvement and crucially in the new world influencing patient and commissioner perceptions.
Cynics will say that a focus on the relationship between regulation and reputation is all about managing the message, spin and an unworthy focus for the board. The reality is this is part of the patient experience and one of the factors that inform how we feel about the organisations that care for us.
So what lessons can the NHS learn from the private sector? Preparation and testing is a good starting point. The mystery shopper is used by the retail sector to encourage quality service throughout the year. This is a powerful technique that is beginning to be used by some trusts and could be employed more widely by the NHS to ensure that hospitals are ready for inspection at any point. Embracing technology is also truly transformational.
My experience indicates that many hospital chief executives still take it on trust that their wards are being run to a high standard, signalling an alarming lack of certainty. Too often harsh lessons then have to be learnt before safeguards are put in place. As we are all aware in healthcare, these triggers often involve some sort of tragedy. The Francis Report highlighted “systemic failings” and the impact a data disconnect between the wards and the board can have. It highlighted that if effective governance is absent, there is no means of ensuring that the data supplied, either externally to regulators or internally to the board, is a reliable measure of performance.
This case cogently demonstrates why trusts cannot tolerate compromise on standards or leave themselves vulnerable to cultural and endemic failure.
To protect themselves from accusations of administrative distractions, falling standards and fatal negligence, hospitals need to modernise and invest in technology that will provide complete transparency of how their wards are being run. The technology exists to provide that visibility vis-à-vis quality standards, with the end result of a dramatically minimising human error and interpretation, while providing all teams with the information they need to see each ward or service through the same lens.
Compliance tools will also flag when a hospital is at risk of breaching a minimum standard, enabling the hospital to take pre-emptive action. In an industry that knows only too well that prevention is better than cure, trusts will appreciate the opportunity to assess risk well in advance.
However, information is only valuable when it’s reliable and its providence is close to the coalface. While there are many management dashboards in the marketplace, there are very few that attribute an item of interest to a particular person; which is vital to encouraging a culture of accountability within the organisation. Therefore, it is important that each action, standard and of course risk is owned by an individual and evidence is supplied on the management and progress of the item.
Technology is also crucial to enabling a quick and efficient response to patient concerns. Given the sheer amount of reporting and paperwork currently in use in hospitals, staff will appreciate the speed at which they can now respond to a patient complaint.
For instance, by using an electronic rostering tool, it’s possible to go back in time and look at which staff were working at the time an incident occurred, their skills and training, whether they had worked unsociable shifts back to back etc.
This information provides an accurate picture of whether a ward was equipped to respond to the incident in a timely and appropriate manner. It also empowers the hospital to learn important lessons and set new rules for the future.
Ultimately, hospitals need to stay on the front foot. Good governance relies on ownership and proof of accountability, evidence that defined standards have been met and appropriate action has been taken. At present, a large proportion of hospitals are under pressure to demonstrate good governance without having visibility of the risks that they’re running.
Paradoxically, despite having the strongest business case for modernisation the NHS still relies on many paper-based systems, which are routinely susceptible to human error.
In an environment where an organisation’s future depends on its reputation with the public, patients and commissioners, it has been proven time and time again that there’s no room for acting on blind faith where compliance and governance is concerned.