I’ll never forget how I felt the day I found out I had let down hundreds of patients.
Paper records of referrals to one of the services I was accountable for had been found in a drawer. They had not been entered on to the administration system, and so nobody had contacted the patients to book their appointments.
I felt a strange combination of surprise, shame, and anxiety – competing with an understanding of the need for resolution and outward calm. I remember the concern for others – has anyone been harmed? – competing with a concern for self – will I be blamed? I remember the questions of adequacy: will I know what to do?
It was a day of growing up for me. I was a matter of months into a new role as a young NHS operational manager, having moved from six years in a management consultancy. Suddenly I wasn’t analysing data, writing reports and giving presentations about what someone else should do. I wasn’t diagnosing the problem, considering a range of options and recommending a solution for someone else to implement. I was part of the problem, and with my new colleagues I was going to be responsible for developing and delivering the solution.
What followed was an extraordinary effort over a period of months from a team of managers, doctors, nurses, physios and administrators in that service to set this right. We checked records to identify any patients at risk of harm. We contacted patients and GPs to apologise and arrange a date to come into clinic, as well as arranging additional clinics. We investigated the reasons why the referrals hadn’t been registered, and we designed and put into place safeguards to try to prevent a recurrence. All of this was done while paying due attention to the many other competing priorities that arise every day in managing acute health care services.
I don’t assume, by any means, that this particular experience reflects typical reality in other trusts at that time or today, though it has something in common with the evaluation findings of many of our programmes such as Safer Clinical Systems. It was highly situational: a combination of an un-designed system; changes in personnel; inadequate information technology; and human error.
Yet ten years on, similar situations are happening time and again, sometimes on a far greater scale. The Health Service Journal reported a number of stories of hospitals missing thousands of patients from their waiting lists earlier this year. (And those are the few examples of major organisation-wide incidents that get reported.) So it’s reasonable to assume that there will be other NHS employees feeling that same sense of isolation that I did.
At the time, I looked for support from others within our trust with comparable experience. But I didn’t look far beyond. I didn’t know how, and perhaps didn’t have the humility or courage to ask for help from as many people as I could have. The trust provided demand and capacity planning tools. But I had limited access to evidence on what changes we might make that would actually improve care and reduce demand. And I also had limited knowledge of methods that might help us design and test new ideas, or to how to engage patients and clinical teams in doing so.
Thanks to a GenerationQ fellowship and my work in the Institute of Global Health Innovation at Imperial College and now the Health Foundation, I’ve since had the opportunity to be exposed to a world of ideas, research, methods, evidence and support that I had no idea existed at the time. Research evidence, guidance and support is not readily accessible for the 1.3 million people in clinical and administrative roles in the NHS – and so many people throughout the NHS work with this kind of isolation.
This is why the improvement research institute being created by the Health Foundation could be so valuable to the health service. The work of the institute will support health care staff in making improvements to the quality of care for patients more effectively and faster – through an unrelenting focus on research that can be applied to pressing real world challenges that NHS staff are facing in delivering improvements in quality.
It’s also important that we undertake the design and development of the institute in the right way. Following an open call for UK universities to express their interest in setting up and running the institute, we have shortlisted four candidates to submit preliminary proposals. We are asking them how they will spread and apply their learning, build the field of improvement research, and develop a collaborative community that undertakes work that is meaningful and helpful to service users, clinicians, managers and system leaders.
There are many seeking to bridge the knowledge and practice gap – such as academic health science networks, collaborations for leadership in applied health research and care and the Q community. Initiatives, such as the institute, can further increase knowledge and connectivity within the UK health care system, and better equip us all to generate, access and share learning: something that should be a unique possibility in a national health service.
Will Warburton is Director of Improvement at the Health Foundation https://twitter.com/will_warburton2