Inside Health
We should trust NHS staff, not targets, to improve care, writes Harry Burns
At present, there seems to be nothing but bad news about the NHS in Scotland. Long waiting times, bullying claims, and inadequate staffing hit the headlines with regularity.
However, an international expert recently spoke out against this tide of negativity when he said: “Scotland’s health system is to be congratulated for a multi-year effort that has produced some of the largest populationwide reductions in surgical deaths ever documented.” This comment was made by no less than Atul Gawande who knows about safety during surgery. Author of several books on the subject, he is professor of surgery at Harvard Medical School. He has degrees from Stanford University, Oxford and Harvard and in 2007, he was appointed director of the World Health Organisation’s effort to reduce surgical deaths. NHS Scotland, it seems, is a world leader in improving survival after surgery.
He was speaking after the publication of a scientific study about a pre-operative checklist, part of a Scotland-wide hospital patient safety initiative. The study of 6.8 million operations performed between 2000 and 2014 found postoperative deaths fell by 36.6 per cent after the checklist was introduced in 2008. It is designed to improve patient safety during operations by promoting teamwork and communication in operating theatres. How was this achieved? Was it the result of a policy statement from ministers? Were targets set by government officials? Did health board chief executives tell surgeons to adopt the checklist? I was a government official in 2007 when this initiative began and none of these things happened.
Ministers and government officials were committed to making healthcare better. They were influenced by evidence from three small projects. Quite simply, the evidence suggested that positive changes occurred when frontline NHS staff were given freedom to test their own ideas. Because they were implementing their own ideas, they were committed to delivering change.
This approach became the Scottish Patient Safety Programme. This programme is not widely known about by the general public and it deserves to be. Launched in 2008, not only has it reduced post-operative mortality but also it has reduced a wide range of complications and problems occurring in hospital patients, such as infections, pressure ulcers, cardiac arrests and deaths from a number of causes. The programme has expanded to include maternity and children’s services and other clinical areas. Our stillbirth rate in Scotland has fallen by 18 per cent and infant mortality has fallen also. These improvements occurred as a result of NHS staff and in some cases patients coming together to suggest improvements. This approach of co-production of better outcomes has now also been adopted in efforts to improve other areas such as child development and educational attainment at school.
The clinical director of NHS Scotland, Professor Jason Leitch, has been instrumental in ensuring steady progress. He has said: “Less harm, fewer infections and death are the measurable outcomes of this work and have now been copied around the world but the more important change is cultural. Safety is now a prominent conversation in all health settings and allows us to build compassion and care into the system.” Instead of having a targets which can have unintended consequences, it seems that those whose daily work is delivering care are best placed to improve it.