“Action speaks louder than words, but not nearly as often” – Mark Twain
“Politics, Power and Persuasion.” Do these three words bring promise or poison to the NHS? The difficulties of providing high quality care to all patients the NHS serves has never been clearer to the public, media or health care professionals. This is regardless of elective or emergency presentation, whether previously healthy or creaking under the strain of co-morbidity or if at the extremes of viability or age. The Francis report has laid bare to all the tragedy that can occur if culture is allowed to degrade quality. There is unlikely to be one sole cause of the events that took place in Mid Staffordshire NHS Foundation trust and maybe taking place in other intuitions identified as being outliers. Both the Keogh and Berwick reviews provided an opportunity to understand the complexity of the underlying reasons. Whether we should read into the fact they were, as per NHS England’s website, reviews rather than reports only time will tell. Simon Denegri, NIHR National Director for Public Participation and Engagement in Research has produced fantastic word clouds of both reviews and the Francis report [1].
“Review”, “Trust”, “Quality” in Keogh and “NHS” “Safety” “Patient” in Berwick were the three most used words. Interestingly “Culture” and “Engagement” were not quite as prominent as one may have expected in the word clouds. These qualities, however, are often cited as reasons for deterioration in the standards expected from clinical staff and health care managers. This demonstrates that analysing words alone is not useful in making judgements. However the word clouds do tell us about a positive mindset, a proactive mentality on behalf of the review groups, to clearly state that the culture of blame in the NHS cannot continue.
How do “Politics, Power and Persuasion” fit with these reviews? Well these words made it to neither of the word clouds. They are also not words which have always sat comfortably with the NHS.
The Health Service consistently rates as something the British public are most proud of, something politicians are acutely aware of. And yet a fundamental issue has yet to be publically debated. The population continues to grow, and age, at a rate technology and evidence based practice cannot keep pace with. Health care costs continue to rise in a period of austerity which currently has no clear end. Do the public, health care sector and government have a clear view, together, of how the NHS will exist in a way which maintains its core purpose of providing free care at point of delivery?
Closely linked to politics is power. It is increasingly recognised command-and-control is a model which fails to deliver a culture in which quality care can be delivered [2]. And yet this model persists, with traditional hierarchies and silos ingrained into the fabric of health care organisations. The Keogh review represents an approach by which this can be addressed. Removing an emphasis on the most ‘senior’ person and utilising, for example, patients and junior health care professionals. Ultimately demonstrating a different mindset to a power based culture.
And persuasion; if people need persuading then little will change. Finding a way to find common values will be instrumental in creating the cultures necessary to avoid future Francis reports. Berwick aimed to demonstrate that it is not rules and regulations that will bring the best out of the health care workforce it is a shared belief that quality and safety is paramount. Not because people are told this but because they believe it.
Politics, Power and Persuasion – perhaps three words the NHS could do without as quality, culture and safety are things you can action.
[1] http://simondenegri.com/2013/08/11/the-language-of-francis-keogh-and-berwick-on-the-nhs-in-pictures/
[2] www.kingsfund.org.uk/audio-video/michael-west-developing-cultures-high-quality-care
