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Florence Nightingale Foundation Annual Conference February 2014.

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Presentation on theme: "Florence Nightingale Foundation Annual Conference February 2014."— Presentation transcript:

1 Florence Nightingale Foundation Annual Conference February 2014

2 leadership Putting patients first Complaints handling Professional regulation of fitness to practice Regulating healthcare systems Standards Collection of real time data to measure quality Performance Management Promotion of NHS Constitution values Openness, transparency and candour Universal culture

3 The trouble with culture is everyone blames it when things go wrong but no-one really knows what it is or how to change it - Prof John Glasby Its how we do things round here - Prof Charles Vincent What are we going to work for today ? – Prof Sir Ian Kennedy Organisational culture is informed by the nature of its leadership – Robert Francis QC Its what people do when no one is looking – comment about bankers

4 We are undoing 30 years of culture – Anthony Jenkins

5 The Francis report is a powerful reminder that we need a renewed focus on hearing and understanding what patients are saying. Ruth Thorlby, senior fellow Nuffield Trust

6 Evidence of poor care in a range of settings Bristol Royal Infirmary – 1984 – 95. Report 2001 Allitt 1991. Report 1994 Shipman 1998. Report 2000 Climbe 1999 – 2000. Report 2003 Alder Hey - 2001 Mid Staffordshire NHS Foundation Trust – 2005 -08 Public Inquiry report 2013 Baby P – 2006 – 07. Report March 2009 Maidstone and Tunbridge Wells 2007. Report Oct 2007 Ombudsman Report – elderly care 2001 Patients Association Reports 2011 / 2012 Winterbourne View – 2011. Report Dec 2012

7 Whilst there must be individual accountability for breaches of standards, the reality is that in most instances of poor care and avoidable harm arise from a much more complex set of circumstances. Systems and processes, pressure of work, quality of leadership and the cultural mind-set of the organisation are crucial factors.

8 Patients fear of upsetting staff Forceful style of management Target driven priorities Lack of appreciation of risks for patients Clinician dissengement from management Low staff moral Isolation – lack of strong associations Lack of openness Acceptance of poor standards of conduct / behaviour Reliance on external assessments Denial / defensiveness NB. Echoes of cultural issues throughout healthcare not just Mid Staffs

9 Research demonstrates a number of key factors which are necessary to maximise staff commitment, engagement and productivity and linked to 4 themes ; * resources to deliver *support to do the job *a job that offers chance to develop *the opportunity to improve team working Ipsos Mori 2008 What matters to staff in the NHS

10 It is especially important that organisations do more to ensure the engagement and health and well being of their staff. Professor Michael West – lead author

11 The results reinforce the need for a much greater focus on staff management and engagement – we know there is a clear correlation between a passive staff experience and better health outcomes. HPMA President

12 You need to light fires inside people not under people - South Tees Hospitals NHS FT

13 The environment of care is broader than the notions of patient or person centred care. Staff too need an enriched environment to create the same for patients.


15 Common set of values and standards shared throughout the system Committed leadership at all levels to the values A system that recognises and applies values of transparency, honesty and candour. Freely available, useful full information on attainments of values and standards The use of a tool or methodology to measure the cultural health of all parts of the system Organisational stability - ----Mid Staffordshire Public Inquiry Report.

16 Acceptance that patients needs come before ones own Recognition of the need to empathise with patients and other service users Willingness to provide patients with the assistance one would want for oneself or refer to someone who can help Willingness to listen to patients to discover what they want for themselves Willingness to work together for the benefit of patients A commitment to draw attention about safety and welfare to those who can address them – Mid Staffordshire Public Inquiry Report

17 Develop a clear vision for quality care Embed key values / behaviours that could make a difference Encourage use of data to drive quality and safety Find simple measures to address consistency, and complacency Ensure a recognition of human factors Act as Role models / Champions / Mentors Dont assume others will act – misplaced trust Strong leadership

18 Responsible for developing a patient safety culture - Assurance - Duty of candour - Human factors – NQB Concordat - Leadership

19 Effectiveness and outcomes Patient safety Patient experience

20 Trusts should embed early warning systems Have people with expertise to scrutinise data Real time feedback Patients and Clinicians more involved in inspections Skill mix reflects acuity Harness the ideas of students

21 Maintaining a safety culture indeed any kind of culture, requires leadership and on-going work and commitment from everyone concerned – Prof Charles Vincent in evidence to the Mid Staffordshire Public Inquiry

22 43 % of senior managers and leaders said that organisational culture was the biggest obstacle to improving care. Kings Fund Leadership Review. 2013


24 Courage for change Abandon blame Transparency at all levels Functions relating to safety and improvement are vested clearly and simply Give people in the NHS top to bottom – career long help to learn Make sure pride and joy in work, not fear, infuse the NHS.

25 Looking is not seeing. Listening is not hearing. It is possible to miss so much that is right in front of us if we lack the categories and skills to notice. The greatest of these skills is, perhaps, to put aside our expectations, and to stay open to the actual. Donald M Berwick.

26 Dont just do something, stand there. – Alice in Wonderland

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