Guest Post by Robin Twyman, Consul (Business and Government Affairs), UK Government Office, Seattle
This week, British Secretary of State for Health Jeremy Hunt delivered a major health policy speech at Seattle’s Virginia Mason Hospital, announcing a new challenge for the National Health Service in England. At face value, that seems a bit odd. Why deliver a speech almost 5,000 miles away from those it will affect? Because it’s here that we found the answer to the problem we want to solve in England: better patient safety.
In March 2009, the Healthcare Commission published a report into the Mid Staffordshire hospital which revealed cruelty, neglect and serious failures there in patient care from 2005-2008. A subsequent report in 2013 by Robert Francis QC concluded that the Mid-Staffordshire hospital had a culture which focussed on business, not patients; gave more weight to positive results than spotting issues of concern; measured metrics which did not focus on the effect on patients; had too much tolerance of poor standards; and assumptions that performance monitoring was someone else’s responsibility.
Ten years ago, Virginia Mason experienced its own patient safety tragedy, with the tragic death of Mrs. Mary McClinton. It confronted the challenge and turned things around. Under CEO Dr. Gary Kaplan’s inspired leadership, Virginia Mason is now one of the safest hospitals in the world. So Mr. Hunt wanted to come and see it for himself. He was accompanied by Professor Sir Mike Richards (Chief Inspector of Hospitals, Care Quality Commission) and Mike Durkin (Director of Patient Safety, NHS England), both key senior officials in overseeing patient safety in NHS England.
Over two days this week, Dr. Kaplan and his team taught us about the Virginia Mason Production System, and the transparency and safety checks which “stop the line.” We visited the Jones Pavilion Orthopedic Unit, the Kaizen Promotion Office Accountability Wall, saw the Med Tele Andon System in operation, and learnt about adopting technology, electronic medical records, and flow to ensure patient safety. Along the way, we witnessed commitment to delivering appropriate and defect-free medical care, and the elimination of waste. And saw “better never stops.”
This all set the scene for Mr. Hunt’s speech on 26 March at Virginia Mason’s Volney Richmond Auditorium. The speech announced a new ambition for the English NHS to reduce avoidable harm by a half, reduce the costs of harm by one half and in doing so, contribute to saving up to 6,000 lives over the next three years. No one underestimates the challenge of delivering change in 260 hospitals employing 1.3 million people. But it can be done. We have the advantages of a unified, national system, a dedicated NHS staff, and improvements in surgery, hospital infections and the safe use of medicines to build upon.
Budgets are constantly under pressure, and so the issue of resources comes up. Can we afford to do all this? We believe this is a false argument, both ethically and economically. Safety is not a luxury that we’d like to be able to afford one day. It’s what patients expect now. Mr. Hunt also argued in his speech that unsafe care ends up being more − not less − expensive. Both in terms of litigation and bed days. Our visit to Virginia Mason reinforced our impression that the best hospitals deliver safe care on tight budgets.
Some of the specific measures that Mr. Hunt announced in his speech include:
- an NHS campaign for our hospitals to Sign up to Safety (12 hospitals have already signed up);
- monitoring by the Chief Inspector of Hospitals;
- the recruitment of 5,000 safety champions as local safety change experts and evangelists;
- encouraging a culture of openness and transparency, empowering staff to “stop the line” when problems occur; and
- a duty of candour to tell patients if they have been harmed.
But, as we saw with Virginia Mason’s Accountability Wall, it all needs to be monitored effectively. So NHS England will be developing a new and more reliable system to measure actual harm and allow comparisons.
Mr. Hunt and UK health officials have been privileged this week to come to Seattle to see one of the world’s safest hospitals. The challenge begins now for us to deliver Mr. Hunt’s vision for the NHS to be the world’s safest health care system.
Robin Twyman has been the UK’s Consul (Business and Government Affairs) in Seattle since January 2013. He has spent the last 27 years on diplomatic assignments in America, Africa, Europe and the Middle East. His assignments at home and abroad have covered a range of foreign policy, security policy and commercial diplomacy duties. On his London assignments, Robin has managed the UK’s Afghanistan Counter Narcotics programme, led the FCO’s Falkland Islands team, and served as a Foreign Office spokesman.