As the Healthcare Commission cleared the decks in preparation for the launch of the Care Quality Commission on 1 April, some of its final reports made chastening reading for all of us involved in the delivery of healthcare that should be safe, effective and a good experience for patients.
The sad thing is, we have been here before. Perhaps the even sadder thing is that we may be here again. So what can boards do about it?
In February 2008, the Healthcare Commission issued the report Learning from Investigations and some of the key findings then sound very familiar now:
- failures in leadership to establish and maintain a culture of safety;
- poorly managed organisational change;
- poor understanding of arrangements to safeguard vulnerable adults;
- professional staff tolerating poor conditions rather than speaking out about their concerns;
- lack of key information at board level.
These themes cropped up again in March and serious questions have been asked about why we have not learned the lessons of the past. Yet we know that chairs and non-executive and executive directors all have an important role in working together to address these problems. There are some simple questions we can all ask ourselves:
Chairs What is on your board agenda? Do patient safety, experience and outcomes get the time and attention they deserve? Do you and your boards recognise your responsibilities for these issues? Can you demonstrate this if someone came along and asked?
Non-executive directors Are you playing your part in establishing and maintaining a culture of safety that delivers effective outcomes and good patient experiences? Are you satisfied with the information you are receiving and, if not, have you challenged your executive directors to improve?
Executive directors Does the information you provide help your board to deliver on its responsibilities for patient safety? Are you supporting a culture that allows problems to be identified, discussed and addressed? Are lessons learned from good practice and when things go wrong?
It is, however, too easy for those of us who sit in national organisations to suggest that everything would be fine if only the commissioners and providers of local services got their act together. We have responsibilities too and we need to deliver on them as well.
The best boards
At the Appointments Commission we are acutely aware of this.
We need to make sure that:
- we are appointing the best possible people to sit as chairs and non-executive directors on boards so that the challenge, scrutiny and strategic drive they provide really can make a difference;
- the boards we are appointing are balanced with different experience and expertise to deliver rigorous scrutiny of all aspects of the board’s agenda;
- the induction training we provide supports new chairs and non-executives in these difficult roles and gives them the understanding they need of their full role and responsibilities.
A critical bit of this jigsaw is missing. Many reports criticise the lack of information provided to boards, or that the information provided was dense, incomprehensible and failed to highlight the key issues.
But do we have a collective understanding about what good looks like for boards when they are seeking assurance on patient care and safety? And even if we did, do we know what we should be doing with it, what questions we should be asking and how the answers should be interpreted?
These are questions that new board members are legitimately asking and although there have been various attempts by different organisations to provide answers there is still some way to go to give boards the support they deserve.