Only by listening to patients and staff can we truly appreciate the standard of services for which we are responsible, says Peter Homa
I recently contributed towards an evening seminar with senior European healthcare leaders, policy makers and regulators hosted by Professor Julian Le Grand at the London School of Economics. This seminar brought together colleagues from different European health systems to compare and contrast approaches to quality assurance. These discussions were held shortly after publication of the profoundly important Francis report.
During the seminar I shared my reflections on what will be the implications of the report on the NHS. My remarks drew upon my experience of setting up new organisations, including the challenge of mergers. I also described some of the work we are doing at Nottingham University Hospitals Trust to better place patients and their wellbeing at the forefront of all we do.
An issue that emerged during the discussion was how as board members do we know what we know about the services for which we are responsible?
How do we as the leaders in hospitals know what we know? Do we rely on heavily aggregated reports or do we seek to triangulate such reports with first-hand experience?
From board to ward
As Robert Francis describes, it is essential to bring together quantitative and qualitative evidence into a coherent statement of the quality of patient care and experience. This evidence includes complaints data, clinical outcomes, nursing and quality dashboards, incidents reports, net promoter scores and sickness absence.
‘A blizzard of action plans will not help achieve what is required’
We have started a “board to ward” review of information, analysis and reporting. This will ensure that the information requirements at clinical team, ward, specialty, directorate and corporate levels are thoughtfully presented and understood.
At the heart of the Francis recommendations is the duty to concentrate on the humanity of patient care and not just the timeliness of its delivery. Central to this is the importance of behavioural values. As board members, we are responsible for modelling the organisation’s values and required behaviours, and supporting staff to do the same.
In Nottingham, we have a long-standing values and behaviours programme called “We are here for you”. We are on course to train 14,000 staff in Nottingham University Hospital’s values and behaviours by the end of the year.
Solving underlying problems
Board members’ responsibilities include understanding as far as possible the experiences of patients and staff. Our response to Francis − building on work already under way − will involve closer listening to patients and staff. We are also giving careful thought to our existing methods, systems and processes for quality assurance.
Examples of how we try to do this include regular patient safety conversations where board members talk with the front-line staff. These conversations provide a forum for staff to raise concerns directly with board members. It is among the most valuable methods for gaining deep insight into the challenges faced by staff.
Spending time with front-line staff continues our learning and understanding about how we can improve patient and staff care. During such conversations, we listen to the staff, acknowledge their successes and take personal responsibility to resolve their problems.
A blizzard of action plans will not help achieve what is required. The approaches and methods that created the need for the Francis inquiry cannot be relied on to solve the underlying problems.
Another powerful way in which our board seeks to understand how our patients feel about their care and experience is through the “the 15 steps challenge”. This involves walking into a ward or department for 15 steps; stopping and listening; watching and smelling.
‘There is no better way to understand how to help patients and staff than spending time listening to them’
This simple yet powerful method helps reveal so many facets of patient care. We use the 15 steps method in Nottingham to better understand how patients feel in our care and how rapid improvements can be made from patient feedback.
These first impressions count in both clinical and non-clinical areas. The challenge takes its name from a comment made by a mother in a patient’s consultation workshop. She said: “I can tell what kind of care my daughter is going to get within 15 steps of walking on to a ward.”
We were so impressed by the technique that Nottingham University Hospitals became the first trust in the country to implement the challenge across all of our inpatient wards − 80 at the Queen’s Medical Centre and Nottingham City Hospital.
Like many leaders, I spend time with front-line staff on a regular basis to understand the great work being done and how it can be better supported. Last month I joined our logistics team and learnt a great deal about the valuable work they are doing to ensure safe patient care. I listened and learnt about the frustrations and triumphs of this dedicated team. As Peter Barrett, our chairman, sagely advises, if you only ask questions you only get answers. There is no better way to understand how to help patients and staff than spending time listening to them.
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Peter Homa is chief executive at Nottingham University Hospitals Trust