Martin McShane: A day at the Mid Staffordshire foundation trust enquiry

Martin McShaneI was privileged to be invited to the patient experience seminar being held as part of the Mid Staffordshire enquiry. I felt as though I was participating in one of the best development sessions I have experienced as a clinician and manager. The morning was filled with three excellent presentations. First up was Paul Hodgkin who has a passion for using patient feedback to improve care. As he vividly portrayed, there is a tsunami of potential feedback out on the web and the NHS needs to learn how to surf it, not fight it. His talk brought alive the power of stories to drive change. They are much more compelling than ratings and, in his experience, at least 50% of the stories are thanks. Organisations, most often mental health trusts, which value and understand this sort of feedback are using it to foster service improvement and putting it out to the frontline where people can use it to make positive changes.

The second talk was by Julian Hartley from Manchester. An acute trust CEO, he enthralled the seminar with his personal story of experiencing severe trauma (though as a fellow cyclist it made me shudder). He recounted, how, as the Halo brace was being screwed into his skull to stabilise his C6/7 fracture, it was the nurse who held his hand that provided the human touch he valued immensely. He went on to articulate how important Board leadership, allied to culture, systems, and processes, was to ensuring quality: creating safe and effective processes for delivering care, which provides a good patient experience.

The final presentation came from Victoria Simpson from John Lewis. She provided an insight into the principles that underpin the way the firm focuses on creating a partnership which aligns employee, customer, and business interests. What intrigued me was how the balance is struck between giving employees flexibility when necessary, whilst also implementing rigorous processes and procedures to ensure customers have a great experience. There was an emphasis on everyone owning complaints. People who make complaints are often frightened. People receiving complaints are often fearful. Fear drives behaviours. Giving people skills to reduce those fears makes dealing with complaints more successful and John Lewis endeavours to measure the quality of complaint resolution not just the numbers.

I can already hear the howls of protest that health care is much more complex than retail but even John Lewis learns from other companies and sectors how to improve. The NHS must at least be open to ideas from outside. There is, I felt, much that we could adopt or adapt from John Lewis.

I came away impressed and better informed, but also troubled. The enquiry seemed to be about hospitals. Hospitals are only part of a wider system. Maybe, if we did a system root-cause analysis, the conclusion might be that the reason the NHS is failing patients is not due to isolated problems but due to a deeper malaise. Maybe we have a system that is designed to produce such problems, a system that was created to address the problems of the 20th century not those of the 21st. The problems we face now are not going to be made better just by better leadership, or by collating patient stories. Perhaps what we need to do is stop trying to make the way we have always done things work better.

Maybe what we need to do is really do things differently – right across the whole system?

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.

  • I also had the privilege of attending this and several of the other Mid Staffs Inquiry seminar sessions.  I whole-heartedly agree with Martin's comments and especially endorse the idea that it is time to stop applying single focus fixes to fundamentally systemic problems.  I'd like to think that we'll be able to use the opportunity afforded by the terrible tragedies of Mid Staffs to really tackle some of these pressing issues.  Problem is that I thought that about Bristol, Climbe, Shipman and Baby P. 

    To quote the husband of a patient who suffered poor care at Mid Staffs (as re-quoted by Inquiry Chairman, Robert Francis)  “I am fed up with people talking about bloody lessons learnt”  – Surely, it is time to act?