Some sombre news recently, with the revelation that the number of cases of “alleged poor care” being investigated at the maternity unit of Shrewsbury and Telford Hospital Trust has now risen to over 100 (from the 23 included in the original brief last year).
The expression “poor care” appears to be a considerable understatement, with allegations that some (many?) of the cases concerned ended with the avoidable death of a baby.
Don’t know about you, but I was in no way reassured by the statement by the Trust that we should bear in mind that these cases arose over a period of some twenty years ….
The amount paid out by the NHS in damages for clinical negligence last year exceeded £1billion (yes, you read that correctly – over a billion pounds).
The reaction of Ms Emma Hallinan (director of claims at the Medical Protection Society) speaks volumes – after expressing worry that the cost of claims continues to rise, she said “it is important that there is reasonable compensation for patients harmed following clinical negligence, but a balance must be struck against society’s ability to pay …. legal reform is required to strike a balance between compensation that is reasonable, but also affordable – this includes the introduction of a limit on future care costs ….”.
In other words, if the claims rise, cap the payout. How about taking steps to reduce the number of claims?
No doubt the inquiry will throw light on this in due course – but on the face of it this is the latest in a long line of scandals in the NHS which have been exacerbated by the culture of defensiveness and stonewalling inherent in that organisation.
What effect does the organisation’s culture have on this issue?
Step forward Mr Matthew Syed. Not content with writing on cricket for the Times (a job which, one would think, leaves no higher achievement possible), Mr S is a double Olympian (at table tennis), a three times Commonwealth Champion, and has written several books, one of which is called Black Box Thinking. In the book, Mr S contrasts the culture of the NHS in regard to mistakes with that in the aviation industry – let’s call these Culture A and Culture B.
Under Culture A, it’s vital that mistakes are denied whenever possible (initially to oneself, then to the powers that be) (or the public might sue us), leading to a propensity to blame others while concealing our own mistakes – this “obliterates openness and spawns cover-ups. It destroys the vital information we need in order to learn”.
Culture B, on the other hand, “is about harnessing the benefits of learning from failure while reducing its cost”, and actively encourages the sharing of mistakes in order to learn the lessons and try to prevent a recurrence. This active encouragement is necessary to counteract the human default position – “when we are confronted with evidence that challenges our deeply held beliefs we are more likely to reframe the evidence than we are to alter our beliefs. We simply invent new reasons, new justifications, new explanations…. Sometimes we ignore the evidence altogether”.
The result is that the airline industry is incredibly safe – in 2013 there were 36.4 million commercial flights worldwide carrying more than 3 billion passengers. 210 people died – i.e. for every one million flights on western-built jets there were 0.41 accidents – the equivalent of one accident per 2.4 million flights.
In contrast to the health sector, the airline industry has an open culture, with active encouragement to pilots and other staff to share mistakes in order for everyone to learn. And it wasn’t always like that – the United Airlines Flight 173 crash in 1978 was the catalyst for the gradual change that has led to the present system of CRM (Crew Resource Management), which fosters a less authoritarian cockpit culture, where co-pilots are encouraged to question captains if they observe them making mistakes – thus avoiding “captainitis”.
Hand on heart, how open is the culture in your business? Do you actively encourage your staff to (politely!) question your decisions if they feel you may have missed something?
But perhaps not many (if any) of your staff have the necessary knowledge or experience (or self-confidence) to ask the key question?
How would it be if you met seven other business owners (in independent businesses) every month and invited them to challenge your decisions and offer advice?
Worth a thought …..
By Tom Morton – TAB Harrogate
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