Laying the groundwork for change at Mid Staffs

Sir Stephen Moss became chair of the Mid Staffordshire NHS Foundation Trust in the immediate aftermath of the Healthcare Commission’s report of severe failings in 2009. He led the trust through the first three years of its work to transform safety and quality of care. He describes what he discovered when he joined, and how he helped steer the trust on to the right course.

For me, the whole story of Mid Staffordshire NHS Foundation Trust is one of a trust that lost its way. It lost its focus on what it was there to do: to keep patients safe. I became chair in 2009, shortly after the Healthcare Commission report highlighting serious failures in care.

I saw the role as a great opportunity to try and make things better for patients. I enjoy helping struggling organisations, and as a nurse the patient focus has stayed at the forefront of my own value set. I’ve spent my entire career in the NHS and this was the toughest job I’ve done, but I was fortunate to work with the most fantastic team of colleagues.

I moved on at the end of my three years. Both the chief executive and I agreed that once the Trust was stabilised and showing evidence of improvement in the quality of care, we would move on to make way for a new leadership team to deliver the longer-term sustainable improvement needed.

When I joined, I found a complete lack of governance around patient safety and quality of clinical practice. Instead of supporting the work of frontline teams in delivering clinical care, the board was working to a completely different agenda, paying slavish attention to delivering targets and authorisation for foundation trust status. Meanwhile, some fundamental issues, like the level of clinical supervision and staffing levels, had been allowed to deteriorate over time. Not every aspect of the Trust was bad, but in many areas staff were facing impossible situations.

Fundamentally, the Trust wasn’t a learning organisation. As it wasn’t listening to patients, the local community or staff, it couldn’t use their complaints as a vehicle for improvement. Worryingly, we were seeing the same incidents occurring time and again, because no one was getting under the skin of what was going on.

It wasn’t immediately obvious, though. If you looked at the systems and processes for managing risks, you could be forgiven for being quite impressed. But a closer look would show that they weren’t getting to the heart of issues and were often unrealistic, setting people up to fail. Staff who did raise concerns were ostracised or sidelined, while others were fearful of speaking up because of a culture of bullying. So staff came in, heads down, not feeling engaged or part of making the Trust better – just totally war weary.

Our work to turn around the Trust has involved defining the organisational values and raising the profile of patient safety in everybody’s agenda – not least, that of the board. One mechanism was to invite patients into board meetings to describe an experience such as contracting MRSA at the Trust and how that had affected their life. That was a very powerful way of putting issues such as financial decisions into context.

We made a point of proactively seeking feedback from patients, and encouraged the board to spend time in the clinical areas to gather feedback from patients and staff. Our director of patient experience made sure that the information gathered was used to deliver improvements.

I wish I could say that the Trust was well on the way in terms of making significant progress, but developing a safety culture doesn’t happen overnight. My first two years were about stabilising the organisation and rooting out bad practice. Only once we knew where to focus our efforts could we start working up an approach of continuous quality improvement, moving away from action plans and initiatives and into the heart of cultural change.

The forthcoming Francis report will focus on regulation. I hope we will see a model of regulation that raises public confidence while placing less of a burden on trusts – more streamlined, more effective and more joined up. But what we have learnt is that whatever the regulators say, trusts must check their findings against the views of patients, staff and communities to make sure they are getting a true picture of what needs doing.