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Tuesday, February 26, 2013

Developing cultures of high-quality care

#kfleadership Excellent lecture at @TheKingsFund this evening by Professor Michael West. Here are some of my notes.

When he left college West was short of money, so he took a job in the coal mines. Productivity was important to everyone, and the pay at the end of the week depended on the quantity of coal extracted. But there was one thing more important than productivity, namely safety.

In many organizations this would just be lip service. But in the coal mines, safety was taken very seriously, and management actions were completely congruent with this.

West argued that the same should apply in the Health Service. Of course productivity is fundamentally important, but the number one priority should not be productivity but high-quality and safe patient care.

Valuing patients and staff turns out to be good management. West's argument is not merely based on rhetoric, but is supported by data. Patient outcomes and patient satisfaction are highly correlated with staff satisfaction and morale, and these in turn are correlated with staff engagement, which West defined in terms of three things: pride, intrinsic engagement and involvement in decisions. Ultimately this links back to improved productivity.

Someone in the audience objected that productivity must always be the top priority, otherwise you risk running out of money to pay for patient care. West replied that productivity follows from good people management. He agreed that the NHS has a great deal to learn from the private sector, and expressed a hope that private sector expertise (including non-executive board members) would not be limited to the Marketing and Finance perspectives.

West affirmed that the NHS is full of intelligent and highly motivated people, and said that the traditional command and control mode of leadership was such a waste of resource. The key role of leaders is to learn from staff, and to realize the potential of the people.

People at all levels require courage to accept challenging targets - in other words, to strive for things that they won't always achieve. The organization must accept and learn from failure to reach these targets. Blaming people for failure to excel is not only stupid and unfair, it is also counter-productive, because it makes people risk-averse and inhibits them from striving for anything that isn't guaranteed in advance.

Leadership includes the courage to seek unwelcome information - for example feedback that indicates things not going well.

After the lecture, I was chatting to a group from a London teaching hospital about accountability. As I see it, accountability doesn't only mean taking responsibility for the consequences of one's decisions (such as short-sighted cost-cutting) but also taking responsibility for what one chooses to pay attention to. One of the classic examples in Moral Philosophy concerns a ship owner who sends a ship to sea without bothering to check whether the ship was sea-worthy. Some argue that the ship owner cannot be held responsible for the deaths of the sailors, because he didn't actually know that the ship would sink. I think most people would see the ship owner having a moral duty of diligence, and would regard him as accountable for neglecting this duty.

In the current climate, the NHS leadership has a duty to achieve high quality patient care and productivity, and the evidence from Professor West is that this can best be achieved by engaging staff at all levels. Executive boards must surely be held accountable if they neglect to do this.

See also Culture of Fear (Storify, 27 Feb 2013)

The ship-owner example can be found in an essay called "The Ethics of Belief" (1877) by W.K. Clifford, in which he states that "it is wrong always, everywhere, and for anyone, to believe anything upon insufficient evidence".

Updated 28 Feb 2013

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