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Care and compassion must begin at board level

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Governments around the world have been committed to ensuring their healthcare systems provide safe and high-quality care for over a decade (which begs the question, what were they committed to before?).

Yet despite a plethora of initiatives and policies, patients continue to suffer avoidable harm and substandard care.

As we know only too well in the UK, the variation in standards of NHS care is a major problem. Many organisations have made real progress in reducing harm and poor care, while others just don’t seem able to get to grips with the problem. So why is it that a single (at least for the moment) healthcare system can’t achieve universally high standards?

This question was the focus of a major article published in BMJ Quality and Safety, which gives concrete evidence to back up what most people probably suspected anyway. The authors, from eight UK universities, have synthesised a number of separate sub-studies into a large, multimethod study of culture and behaviour in the NHS that has produced an impressively detailed picture of how the service operates.

Data came from hundreds of interviews with frontline staff and senior managers, survey responses and focus group interviews from patients and carers, observations of practice, and a huge amount of performance data and minutes from trust board meetings.

Almost all the professionals interviewed were committed to the ideals of safe, high-quality care and good patient experience. Many also identified care and compassion as their most deeply felt personal-professional commitment. So why can’t they all achieve this?

Well, surprise surprise, the key influences are the actions taken and decisions made at board level. The best care is provided in organisations with clear goals, adequate staff with the right skill mix, and systems that function effectively. While most individual frontline staff may want to do the best for their patients, it is largely the people at the top who determine whether they can achieve this.

Of course health professionals are responsible for their own actions, and ward and team leaders can do much to set standards in their area. However, individual good intentions simply aren’t enough if their organisation doesn’t function in a way that enables staff to fulfil these intentions, and doesn’t value and motivate them.

As the authors conclude: “Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring and compassionate cultures by ensuring that staff feel valued, respected, engaged and supported.”

Let’s hope NHS leaders, from the Department of Health down, read and act on this important study – and create the conditions in which you can achieve your aspirations for your patients.

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