1. Professor Lesley Moore Florence Nightingale Scholar National Teaching Fellow Churchill Fellow FRSA

2. Aims of the paper: To share salient points based on personal experiences as an informal carer and more recently as an inpatient of Welsh healthcare, and current national issues, and To raise important action points for changing the culture of the NHS.

3. Who are classified as patients in this century? “Patients are all the people who experience NHS Wales care and services. Alongside listening to patients, organisations also need to listen to families and carers.” (Williams, A. 2013. “The Listening Organisation: Ensuring care is person-centred in NHS Wales.” Cardiff 1000 Lives Plus. P7)

4. Personal experiences and observations. Poor discharge planning for those wishing to die at home. Poor understanding of the needs of rural communities. Negative attitudes of some staff regards dying at home Long shift patterns Unanswered call bells Priority to meet government targets Conveyor belt surgical care that negates respect and dignity of patients and appropriate discharge planning. Poor staffing levels Apathy of staff, especially to question lack of resources to safely nurse patients. Poor communication between the acute and community sectors. Quality of care seen as less of a priority.

5. Characteristics of the traditional NHS culture. Paternalism Medical dominance Professional power Therapeutic privilege Expert witness Task orientated care Illness model – passive patient

6. Paradigm shifts in Healthcare Culture Paternalism Medical dominance Professional power Therapeutic privilege Expert witness Task orientated care Illness model – passive patient Autonomy Interprofessionalism User balance of power Shared knowledge Holistic care Expert and active patient Health promotion model XYXY

7. Characteristics of the NHS Trust culture reported by Francis(2013).  Bullying  Target-driven priorities  Disengagement by medical leaders  Discouragement of feedback by trainees  Low staff morale  Isolation  Lack of candour  Acceptance of poor standards  Reliance on external assessments  Denial

8. Francis’ call for leadership actions to effect change.  Be visible and set an example  Listen to patients and staff (my preference – actively listen!)  Understand their organisations in depth, at both an operational and strategic level  Think laterally across boundaries (my preference to include networking and reflection, knowing what is happening globally)  Share leadership with all staff, and ensure that they feel valued, respected and supported ( my preference – to include the patients and informal carers.  Be able and willing to challenge others  Be ready and able to exercise collective leadership at board level.

9. A learning organisation (Senge 1999:14) “… continuously expanding its capacity to create its future. For such an organisation, it is not enough merely to survive. “ Survival learning ” or what is more often termed “ adaptive learning ” is important – indeed it is necessary. But for a learning organization, “ adaptive learning ” must be joined by “ generative learning, ” learning that enhances our capacity to create. ”

10. Characteristics of a learning organisation (Clarke 2001). Senior managers must provide a role model. Identify and employ influential members of staff as agents of change. Treat each error as a learning opportunity. Encourage cross-team-working. Teams need to record their experience. Teams must reflect on their experiences together. Reward collaboration. Encourage discussion across and within teams. Ensure that systems exist to capture learning. Review and document performance. Encourage calculated risk taking and experimentation. Delegate responsibility. Ensure that people share in the success of the enterprise. Value individual, team and organisational learning. Communication is vital to ensure a culture of shared beliefs

11. Conclusion: Key Words to act upon in the future Person-centred care Reflect, document and learn Active listening Action learning – work-based learning Co-production of knowledge Sharing knowledge Ethical, transformational leadership at all levels.

12. Remember: The NHS in Wales is just surviving. It does need to be transformed, but this will not happen without a change in the NHS culture.