Dr Don Berwick is a physician, a professor, a leader in patient safety, an inspiration. He is also a good friend of Wales, having been involved as long ago as 2006, helping to create ‘Designed to Deliver’, the Quality Improvement Plan (QUIP), which led to the 1000 Lives Campaign among other things. I have heard him speak several times in Wales on the need to put patient safety at the forefront of our thinking, to adopt quality improvement as the only way forward, and to believe that we can build a better health service for all.After the Mid-Staffordshire scandal broke, and the weighty Francis Report confirmed that many of the worst stories were true, it was announced that Don would be reporting on patient safety in NHS England, and recommending ways forward. That report has now been published, and can be read, along with Don’s letters to senior government officials and senior executives in the health service; the clinicians, managers, and all staff of the NHS; and to the people of England.
The report’s central four points are encapsulated right at the beginning:
- Place the quality of patient care, especially patient safety, above all other aims.
- Engage, empower, and hear patients and carers at all times.
- Foster whole-heartedly the growth and development of all staff, including their ability and support to improve the processes in which they work.
- Embrace transparency unequivocally and everywhere, in the service of accountability, trust, and the growth of knowledge.
Everything else in the report flows from these four points. The report particularly notes the toxic damage caused by creating a workplace culture of fear and blame. It also outlines the leadership behaviours that will help create a great NHS.
If you have heard Don Berwick speak on these topics before, then when you read it, you will find it hard not to read it ‘in his voice’.
But reading it isn’t enough. Because, truthfully, what is in the report is not ground-breaking, or revolutionary. It is what Don has said many times before. It is what he has said to us in Wales. It is what we have tried to do here through the 1000 Lives Campaign, and then through 1000 Lives Plus.
There is a tendency when a report like this is published for it to generate a lot of comment, a lot of excitement, a lot of debate.
Twitter is already full of comments and overwhelmingly they agree. Many attempt to demonstrate alignment in 140 characters. Surely every one has to read it as a personal agenda for change. But if we all agree so well, why do we need the report? Maybe we need to do as he asks: read it carefully.
Ultimately, the test of whether this report will change anything is whether people put it into action on a day-by-day basis, on the frontline, in clinics, surgeries, management meetings, offices and boardrooms. That’s the hard part – not just listening, but taking action in response.
In the past, Don has challenged us all to be mindful that we have two jobs – to do our job, and to improve our job. That is restated in the new report as developing staff both in their ability and their ability to improve.
Earlier this year we launched Improving Quality Together – to get everybody in NHS Wales to the point where they can look at the work they do, identify ways to make it better, and then go on and actually make it better. It will be part of our journey and we must work to ensure its contribution to patient care.
As Don said on one of his many visits to Wales, “Improvement is not a task that begins and ends; it’s a journey that never ends.” For this report to have a lasting legacy, the people commenting now must also commit to improve things, and do it, not just now, but as a new way of working altogether.
Dr Alan Willson is one of the directors of 1000 Lives Plus