Learning from Aristotle, Henry Ford and others… this week’s blog from Professor Stephen Eames looks at patient safety and quality in an ever increasingly challenging climate

There is a view that no amount of external focus can necessarily identify or solve problems inside an organisation and that real change has to come from within.

Henry Ford once said: “Quality means doing it right when no one is looking.”

Many of our staff and organisations are grappling with this mantra in the wake of the most challenging winter period in recent NHS history.

Reflections on my experience in leading organisations over the last 30 years tell me there is always something more you can do, even though you believe you are doing everything you possibly can to succeed. Moreover, we need to maintain and improve in patient safety and quality in an economic and workforce climate that grows more challenging by the minute.

Of course, this is easy to say but much more difficult to do. It requires discipline in traditionally challenging areas like transferring knowledge, collaborative learning, sustaining and embedding improvement and, most of all, ensuring every patient gets the best quality care every time.

The current thinking is that, by breaking down boundaries and integrating systems, it will be easier to meet the quality challenges with all organisations pulling together for the greater good.

Although it’s over a decade old, Becoming a High Reliability Organisation, which was produced for the US Department of Health and Human Services, remains relevant today and still gives insight into how collaboration and system working can be a major force in driving up quality. It draws on experience in the aviation and nuclear industries, which are known for their high reliability in safety and quality.

I emphasise that this is not an improvement methodology like Lean; it’s about introducing a mindset that creates a culture that ignores organisational and professional boundaries, systematically identifies danger signals and responds swiftly and strongly so catastrophes are avoided and safe, consistent high-quality care is provided to patients.

The lessons are that, for quality improvement to succeed, five forces need to be in place:

  • A sensitivity to day-to-day operations, thereby ensuring leaders and staff are constantly aware of the state of systems and processes that affect care.
  • A reluctance to simplify by recognising that while simple processes are good, simple explanations for why things work or fail are risky. In my experience serious failures are often attributed to simple things like communications failure or inadequate training, but these are rarely the full and detailed explanation for why things go wrong.
  • A preoccupation with recognising failure and positively addressing the causes.
  • A deference to expertise so leaders, managers and  supervisors are willing to listen to frontline staff who know how the processes really work and the risks patients face.
  • An in-built resilience by ensuring leaders and staff are trained and prepared to know how to respond when system failures occur.

I’m not offering this as a blueprint as it is clearly a way of thinking. Making this work, as with all these things, is down to  leadership, commitment, strategies that are tuned into the local environment and the skills of leaders and staff to adapt these ideas to suit their own particular situation.

The beauty of this approach, though, is that it costs little to implement and does not depend on a plethora of external sources or resources to succeed.

As Aristotle once said: “Quality is not an act, it is a habit!”

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