As we face ongoing issues in the media regarding the performance of the HSE and those who work in healthcare, I cannot but reflect on how we are not that good at demonstrating where we have had success and how in general, though there are problems overall there are more successes than failures, writes Dr Peter Lachman.
Like all health systems the one in Ireland has problems. Health systems are in reality disease management systems that have failed to develop in a planned systematic way. Organic growth without taking quality and safety into account was the way the service grew – usually in reaction rather than in anticipation. Healthcare centred around hospitals providing disease management always will be problematic. We need to consider how the systems interact to provide a comprehensive health service for all as well as a disease management service. And we need to integrate quality and safety into the fabric of care.
Now back to the current dilemma. Every day clinicians and managers read how “bad” things are; the media thrive on bad stories. This will then translate into burnout, despair and then poor care, of the providers as well as of the patients. Perhaps we should consider taking up two initiatives in the UK which will be adaptable to Ireland.
The first is a programme called The NHS Academy of Fabulous Stuff https://fabnhsstuff.net. Here there is celebration of good things, i.e. of changes that make a difference and can be spread. Staff are rewarded for their good work and can share and celebrate. NHS Staff can load up good stories and feel good about sharing changes. Also there is Change Dayand Weekwhich has spread worldwide and pledges to improve are made.
Our preoccupation with avoiding error and harm in healthcare has resulted in the rise of rules and rigidity, which in turn has cultivated a culture of fear and stifled innovation.
The second initiative is Learning from Excellence https://learningfromexcellence.com where they contend that we learn more from good practice which occurs most of the time rather than from adverse events. It is not to replace the study of harm but to learn from what works well.
They state that “Our preoccupation with avoiding error and harm in healthcare has resulted in the rise of rules and rigidity, which in turn has cultivated a culture of fear and stifled innovation. It is time to redress the balance. We believe that studying excellence in healthcare can create new opportunities for learning and improving resilience and staff morale.”
This is the foundation of building resilience and we need to move to this new way of thinking.
Who will take up the challenge and set up an Irish version of the two programmes? This needs to be done.