I thoroughly endorse Stephen Ramsden's transformational approach to patient safety. However, I believe we could go even further by saying this is exactly what is missing in many other aspects of patient services and, indeed, more generally across the public sector, writes Sue Ward

It seems to me that we are working in a culture of 'management by measurement' and have lost sight of the key ingredient to improvements in any kind of service - people. We measure everything to the nth degree, we do not act without analysing and risk assessing everything we do, activities that used to be part of everyday management are now wrapped up in project management speak, everything we do is carefully planned against every eventuality and duly logged under a plethora of registers.

Call me old fashioned, but isn't this way of working sapping the very essence of what motivates, inspires and impassions us to do our best to make a difference? The excitement of designing a new service, making a change to improve a patient's experience, seeing improvements in performance or simply helping a colleague do their job is sapped by the current culture of breaking everything down so it can be analysed, measured, assessed and logged.

These tools have a role to play, but let's get that role into perspective and strike a healthy balance. Surely it is time to measure only what matters and focus instead on our people - opening their hearts and minds to the possibility of making a real change in an unfettered culture, with their spirits not numbed and dampened by the frankly boring demands of number crunching that management by measurement requires.

It must surely be right to encourage the creativity, energy and innovation that we used to see so that staff can once again feel valued and be excited, thrilled and passionate about doing their very best. It is only this attitude, desire and commitment, coupled with expertise and competence, that really leads to fundamental and lasting improvements because people actually want to make it happen and are inspired and motivated to do so.

Sue Ward was formerly head of resourcing, scheduling and new business at the Healthcare Commission.