Tuesday March 18, 2014
Sir Stephen Moss was Chair of Mid Staffordshire NHS Foundation Trust from August 2009 to January 2012. He talked about the impact that the reports had on the community and staff and what unremitting scrutiny and constant media and political attention felt like.
The Human Touch
Sir Stephen Moss and his Board colleagues experienced the full force of public concern in relation to the nation’s health service. As one of two men brought in to turn the fortunes of Mid-Staffordshire NHS Foundation Trust, when it was pulverized from within and pilloried from without, for having lost sight of its values, and control over its staff, he has become the diagnostician charged with the care of a crumbling patient.
The lessons learned have an impact across all hospitals and all health care, and it isn’t rocket science as he himself pointed out at a Thewlis Graham seminar in London this week. “I have been in the NHS for 42 years and taking over as Chairman of Mid Staffordshire NHS Foundation Trust was without doubt, the toughest job I have ever done. They asked what management theory the Chief Executive and I would use. There is no manual off the shelf that helps you through experiences like this. What you use is simple: judgment.”
Using judgment, Sir Stephen and his colleagues pulled the Trust back from the brink of collapse, and came to conclusions that are familiar to recruitment companies whose business is identifying potential leaders: that the common problems of systemic failure are all functions of poor management of staff, poor quality of governance, and a lack of informed, strategic, values-driven leadership.
In the case of Stafford, that failure was so endemic that even those outside were tarred by it: “It was tough because we were in the middle of a community that had been badly let down by the NHS and it was difficult to handle the relentless depression and anxiety of those we were trying to support.”
“The NHS is about public service. This is something we tend to forget,” he told a spellbound gathering at The Royal Society of Medicine. “I still don’t think we have properly embraced challenge within the NHS. It is only by listening and by challenging that we can move things on, but our professionals are protective of their roles.” This included nurses, said Sir Stephen, who is a Registered Nurse with extensive clinical and managerial experience, including 20 years at Board level.
Moving into territory that is very much the area of Thewlis Graham, he talked about improving the quality of an organization from the top down. “In hospitals with an ingrained culture accepting of mediocre practice and standards, that is what the staff will aspire to. We can’t rely on whistleblowing policies because staff will still not put their heads above the parapets. A Board needs to be living and breathing the values and behaviours it expects from its staff.”
Warming to the subject, and under scrutiny from the heads of organizations that have had to manage the disconnect between what is expected of the NHS and what is delivered at a local level, he pointed to a common internal problem – that the same hospital that is failing its patients in one department can be getting glowing reports from regulators in another.
It was why, he said, patients would praise one ward on a floor, while condemning the ward next door. It was why they would praise one team of nurses, and dread interactions with another. It was time to declare a zero tolerance approach to examples of inappropriate behaviour. There needed to be greater staff development, education, and opportunities for professional growth. The challenge was managing the problem without further eroding morale.
Interestingly, from a recruitment point of view, he pointed to issues around low staff turnovers. Traditionally seen as a signifier of a good employer and a happy workspace, it had proved to be the opposite at Mid-Staffs where turnover was extremely low. “There were no new ideas, and no new thinking,” he said, “The place was in a time warp and our staff felt completely and utterly let down by their leaders.”
Under Sir Stephen’s leadership, Board meetings were open to the public and a good result was not seen as a reason to take one’s foot off the accelerator. He cited an example of the Liverpool Care Pathway used at Mid-Staffs, which had a 97 per cent success rate. By drilling down to numbers and looking at the six people’s deaths that constituted the 3 per cent that was unsuccessful, clinicians were able to better understand and measure what was happening on the wards.
This attention to detail will not, however, offset the problem of morale at failing hospitals. Asked about staff retention when things are bad, and the problems of recruiting replacement staff, he admitted it was very difficult. Hospitals that had come under public scrutiny could often find only temporary staff, which made sustainability difficult. As increasing numbers of elderly are admitted to NHS wards a whole new raft of issues around organizational development will be added to those that have already presented themselves.
Sarah Thewlis suggested this was an area that Thewlis Graham could put under particular scrutiny. The human touch was vital at all levels within the NHS, particularly amongst the managers, leaders and board members who create and nurture organizational culture and practice. We all have a part to play in creating a galvanizing top tier that will generate confidence and aspiration and lead the NHS into ever unknown territories.