Neil Churchill: advice for managers on giving criticism

For NHS managers, it must feel like praise is often forgotten in the rush to criticise. The service ended the year reeling from a series of bad news stories from dirty wards at Basildon to high death rates at, well, Basildon again and elsewhere. HSJ argued that “fear of dangerous services mixed with ignorance of arcane issues such as mortality ratios” not only affects staff motivation but also creates the “perfect media cocktail for a health scare”.

In addition to expert patients, the NHS must expect militant patients

As one of the people involved in dishing out the criticism, I have seen how easy it is for this to happen. In a radio interview about an ambulance trust’s failure to achieve its Care Quality Commission asthma standard, I was asked to comment on an interview with a man who said he would never trust an ambulance to get his son to hospital safely. While he had reasons, his message would surely be interpreted as no confidence in a vital emergency service.

So, why do we criticise?

The first reason is that much criticism is justified. Another story from the dying days of 2009 reported General Medical Council figures that almost one in 10 hospital prescriptions contains errors. As many as 1.7 per cent of these 11,077 errors were “potentially lethal”. That’s 188 lives put at risk during the seven days under study.

This kind of situation can turn toxic if patients or relatives feel apoplectic at the way they are treated when something goes wrong. If the shutters come down after a serious incident - as patients regularly tell me - the chances of further publicity are increased, as people seek the information and recognition they were denied by the NHS through the media.

A second reason is that informed, assertive patients get better quality care.

Poor quality care is often ingrained where patients don’t know they should expect any better, whereas clinical guidelines are more widely followed where patients know what they are entitled to.

In addition to expert patients, the NHS must expect militant patients, as social networks draw attention to variations in care. Patient organisations like mine are encouraging this development.

Patients have both the right to know about the quality of services and the right to receive safe, high quality care. Patient organisations exist in part to help patients access, interpret and use performance data. But, as more data is put in the public domain, we need a new art of giving and receiving criticism to prevent health scares.

For those receiving criticism, it is important not to be too defensive. The ambulance trust I criticised spent too much of the interview complaining that patient care had been safe but that data had not been collected to demonstrate that fact. Most listeners would ask how the trust could assure itself that care was safe if it did not have the data to prove it. Others would conclude that failure to provide good data to the Care Quality Commission was probably predictive of failure to provide safe care.

Such quibbles tend to obscure the stories trusts wish to tell about performance improvement. But failure to recognise that improvement is needed when data suggests otherwise will simply mean media interviews get nowhere beyond the demand for an apology.

For those making the criticisms, data needs to be set in better context. A trust’s failure on its asthma standard will be a concern to Asthma UK, but if a trust is otherwise performing well, that needs to be explicitly recognised. Data by itself does not make information: it needs to be explained and interpreted.

Patient organisations have a duty to ensure that legitimate stories do not become dangerous scares. This is especially important now that journalists rely more on news releases than press conferences for information. We need to be held to account for our performance, too.

It may be possible to build a consensus between the NHS and patient bodies about the way to talk about the reams of new performance data coming online. Bad news makes good copy but charities want good practice to be better known too.

An informal communications plan has already helped improve news coverage of mental health and suicides and a similar approach could ensure data is responsibly used, to the benefit of patients and the NHS.

For criticism is set to grow, not plateau. David Cameron will not be the only politician this year to promise “an information revolution” in the NHS. Our collective challenge will be to make this data a useful tool for patients - not death by a thousand critical cuts.