Comment / In the safety zone

I chaired the HFMA’s ‘post Francis’ conference in April. Although the events at Mid Staffordshire provided the focus, the conference gave finance directors a broader opportunity to have a real up-close-and-personal experience of patient safety.

Speakers told a forensic but compelling story of an organisation that lost sight of its raison d’etre and where staff became institutionalised and lost the passion for quality with devastating consequences.  Former deputy chief executive at the Department of Health and now chief executive of the NHS Trust Development Authority David Flory spoke with a sense of humility about how we as a profession need to sharpen our radar to avoid reoccurrences. But he was also clear about the intense level of effort that will be needed to reshape our service delivery model in the current economic climate.

The wider context of the conference was understanding the vital patient safety agenda and the application of improvement science in line with newly appointed quality guru Don Berwick’s work at the Institute for Healthcare Improvement.

The conference underlined one key issue for me: unless quality is embedded in what we deliver, balancing the books cannot be considered strong financial performance. I think we would all sign up to that statement. But we also need to ensure that we deliver it in practice.

So where does quality fit as part of your organisation’s cost improvement programmes? Mr Berwick suggests 25%-33% of all healthcare spend is waste. This includes activities that simply add no value to patients, but also includes the consequences of avoidable harm – bed days deployed in treating patients for infections, pressure ulcers and hospital-acquired pneumonia. 

Appropriate staffing levels and quality of care need to be engrained in thinking.  If we get this wrong, we overstaff, which is wasteful. If we understaff and there is too much work for too few people, harms and delay will occur.  Finding the ‘sweet spot’ that ensures benefits for taxpayers can only occur with a deep knowledge of what is happening to the patient.

Ministers have set an expectation for themselves and their civil servants to walk in the shoes of those at the frontline. In December, as part of my ‘Knowing the business’ theme I called for us to do exactly that.

Those who have already risen to the challenge talk about the insight this provides. Solutions that seem obvious from the comfort of our desks are often trickier to deliver in a hectic accident and emergency department or on a busy night shift. If you haven’t made your own arrangements yet, I would encourage you to do so.

Shortly after the HFMA event. I was fortunate to hear Mr Berwick address the national patient safety conference (attended by too few finance directors and chief executives). Those of you who heard him at our own annual conference in December will not be surprised to hear he provided a remarkable critique of the Mid Staffordshire problems set in the context of the wider NHS.

He reminded us that all change is not an improvement, but all improvement is change. So if in your economy, like mine, serious planning is afoot to shape services to be fit for purpose for the next 20 years, we need to keep Mr Berwick’s wise counsel in mind. Doing nothing can’t be an option if we are serious about improvement. But at the same time we need to ensure change really does deliver the targeted improvement.

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