On the back of Francis and Keogh, Berwick has raised his flag to fly alongside the others in the call for change in the NHS, and to champion the message that culture and engagement of staff and patients is crucial.
Berwick is clear about the challenges faced in the NHS and suggests four guiding principles to delivering an exceptional health service. These are good not just for the frontline, but for the leadership as well.
1. "Place the quality and safety of patient care above all other aims for the NHS …"
No employee enters the NHS not wanting to do this, but, until relatively recently, operational targets and financial management have taken precedence over delivering high quality patient care. The trade-off between reducing costs and providing best quality care continues to be a major issue. When working with NHS Trusts, we at Unipart have found that with the right tools in place to drive efficiency staff capacity can be found to improve patient care and reduce costs. It’s a matter of investing in your people.
2. "Engage, empower, and hear patients and carers throughout the entire system, and at all times."
Involving patients, carers and the public in reviewing and informing on all the services the NHS delivers is one of the key ways to make sure that the system is providing the best quality care. Consistently staff engagement surveys report high levels of commitment to their work and their patients, but on the flipside staff feel that any suggestions made would not result in actions. We know from our own experience in the NHS, that given the opportunity to see suggestions realised that staff feel encouraged, and thus empowered to continue to identify issues leading to significant improvements in patient care.
3. "Foster wholeheartedly the growth and development of all staff, especially with regard to their ability and opportunity to improve the processes within which they work."
We have repeatedly found that front line NHS staff have the best ideas of how to solve problems and create improvements. The key is to create an environment where the ownership of the processes is handed over to the teams to design. By shifting this ownership and creating effective two way communication structures to complement it we have seen genuine examples of process innovation coming out from the staff on the frontline, who at the end of the day are true experts in their own processes.
4. "Insist upon, and model in your own work, thorough and unequivocal transparency, in the service of accountability, trust, and the growth of knowledge."
The aim within any organisation should be to create a culture of continuous improvement, not blame, by sharing information openly. Having a culture of fear is in the NHS is detrimental to both safety and improvement, the best way to make the NHS safer is to trust the goodwill of staff and help to bring out the best in them at every level of the organisation by supporting a commitment to lifelong learning and openness.
Finally, Berwick instructs us to "Make sure pride and joy in work, not fear, infuse the NHS." This may be nothing new, but every member of the NHS should embrace it.