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7 February 2013
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FMLM and the Francis Report

Once the war of words is over and we have all had the chance to properly digest the Francis Report, the challenge to guarantee that patients and carers experience high quality, compassionate care at all times will really begin. The critical word there is guarantee as both high quality and compassion is everywhere in healthcare in the UK; the issue lies in its consistency.

No-one working in healthcare should hide from their responsibilities to rebuild public confidence but we must acknowledge the complexities and avoid knee-jerk reactions which suggest we are doing something when we are not. Equally, we need to learn the lesson that, in that enormous complexity of interventions which make up care today, only one individual needs to drop their standards for the patient to experience poor quality, lack of compassion and suffer harm.

In the myriad of potential solutions, FMLM is naturally focusing on leadership where the evidence strongly points to a direct link to better care. We are seeking to understand how that link works and to that end have adapted the elegantly simple Sears service-profit chain, the result of a Harvard Business School study.

Sears, a North American department store, was suffering heavy financial losses; it successfully implemented traditional turn-around but recognised that sustainability relied on committed and engaged staff. The model shows that committed and engaged staff measurably serve the customer better – not surprising is it, nor is it hard to extrapolate to healthcare:



Figure 1: FMLM adaptation of the service-profit chain at Sears, Harvard Business School, January-February 1998, pp83-97

Whatever is implemented following Francis, there needs to be a simple ‘staff test’: will this encourage more or less discretionary effort from staff? If the latter, then Mid Staffs will be more likely to recur, not less!

FMLM’s focus is on understanding the chain better and how improvements can be made – what sort of leadership do we need and by whom? How do you improve leadership? etc. Not leaping in at the top of the chain takes courage; not to focus on the bottom of the chain will change little. FMLM believes the experience from other sectors that a well-motivated, engaged, happier workforce will deliver better quality, more compassionate care for patients.

How will FMLM improve culture through good leadership?

  • FMLM is a champion of revalidation and believes that good appraisal will enable staff to receive constructive feedback and identify areas for improvement and development in a supportive environment. Appraisal, done correctly, supports both staff satisfaction and organisational performance. There is evidence which links good appraisal to a reduction in mortality.

  • More information on what FMLM is doing around revalidation.

  • FMLM advocates use of the medical engagement scale to help organisations assess and improve medical engagement.  Organisations where clinicians are engaged in strategic planning and decision making perform better than those where clinicians are excluded from strategic processes of the organisation.

  • FMLM is proud of the large proportion of trainee doctors in its membership and strongly supports change throughout NHS from top to bottom. FMLM already runs the NHS Medical Director’s Clinical Fellows Scheme which will be expanded in 2013 to be more geographically equitable. The scheme allows trainee doctors to learn leadership skills at the very top of large healthcare organisations including the NHS.  FMLM will continue to nurture these future leaders through Medical Student and Trainee Steering Groups. FMLM fully endorses the trainees' perspective on Francis and their response captured in Understanding Francis.

  • FMLM needs time to review the Francis Report in more depth and how it will impact how engage doctors and organisations in leadership. If you are a FMLM member or associate interested in sharing your thoughts, please contact enquiries [at]

(i)The link between Management of People & Patient Mortality in Acute Hospitals. West M et al. Int J HR Management 2002 13:8 1299-1310.

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