My role as Patient Safety Commissioner is to promote the safety of patients in relation to medicines and medical devices and to promote the importance of listening to the views and experience of patients and the public. But we shouldn’t need a new statutory role to tell us this – the whole system should be listening continuously to patients and acting on their feedback.
From visiting trusts and speaking to senior leaders I have seen for myself the difference that visible leadership makes. At one end of the spectrum, trust leaders staying in the executive corridor behind locked doors, too scared to walk around their organisation for fear of being bombarded by negativity at the other end a CEO walking 30,000 steps daily around their trust listening to patients and staff. Where you you rather be treated?
As a GP, I am perplexed as to why the national leadership organisations disconnect themselves from the people receiving and delivering care. In conversations about health and reading the headlines there is so much talk about backlog clearance, efficiency, and cost savings, it’s easy to forget that every day, up and down the country, people are helping people. People who could be harmed by organisations that focus on throughput without putting patient safety at the top of the agenda. But sometimes it feels as though national bodies are on another planet and that people on the frontline aren’t visible until mass action is taken. What’s needed is a reconnection so that there is a better understanding between patients, healthcare professionals, and officials, where patients are seen as members of the team and patient partnership is business as usual. To do this we need a relentless focus on the culture within our organisations.
Connecting with patients and their families is straightforward for clinicians but can be more challenging for many senior leaders. They need to open up their mindset. This particularly applies to non-executive directors, who have an important role to play in observing the culture of their organisations and making constructive recommendations for change where necessary. Listening doesn’t happen by accident. Leaders need to set a strategic intent for their organisations to listen to patient feedback at every level and for this to be used for learning and improvement. They also need to follow up by acting on the issues raised by patients. These leadership behaviours are fundamental to the skills required for Process Safety Management, where the focus is on the causes of harm and how these can be prevented. Too often the health sector focus is on the consequences of harm, with the defensive, dismissive approach that has featured in so many recent reviews.
My role is to help the Government and the healthcare system to listen to patients. Whilst many of the recommendations from First Do Harm have been adopted, the core message of the report, listen to patients, has been overlooked. It’s clear from the way service specifications are written, from the way that harmed patients have not been involved in designing learning and resources, registries, and mesh complication centres. This is also immediately apparent because the boards of DHSC and NHS England do not include a patient story. My hope and expectation are that DHSC, NHS England and other organisations that currently don’t create opportunities for their boards to listen to patients will learn from those who do.
As is often the case, good practice is already happening in providers and elsewhere across the healthcare system. A great example of this is at Hounslow and Richmond Community Healthcare NHS Trust and Kingston NHS FT in west London where I recently met with the patient safety partners, managers and specialists. The Chief Medical Officer was keen to point out that every board meeting starts with a patient story, which has a demonstrable impact on the conversations that follow.
For any organisation that wants to build credibility and avoid being seen as disconnected from frontline realities, including the views and wishes of patients, my recommendation is to create a culture of listening up and following up. Make patients your purpose. Put a patient story at the top of every board agenda. This is a low cost, high impact action and will help to frame the conversations that take place at board. Take opportunities to listen to the needs of patients and families and the impact of policy decisions on patients and those looking after them, be it their family, friends, or your staff. Be visible, approachable and follow up on what you have heard. Show you care. Communicate your actions and engage with everyone affected by your work. Set the tone from the top, set high expectations that this will be the culture of your whole organisation, and use data and patient accounts to know if this is the case.
This is how to build credibility, this will reconnect you with the frontline realities, and this will build trust. This is what the Cumberlege Review, First Do No Harm, called for in 2020. This is what patients and the health system in England need you to do.