How do you change a culture in a vast, complex organisation? Well, first you have to believe it is possible. Take something we can excited about. Let’s use with the London Olympics as an example. The games famously shifted the way the nation views sports and events. They made a cynical country proud, made us feel like winners and boosted our confidence at a time of economic woe. These changes were generated by both the big and the small.
Danny Boyle’s opening ceremony got public momentum going, and every smile by every gamesmaker helped keep it on track. And of course there were the athletes. Years of resolute training made them great, while the tiny things gave them an edge – the cycling team’s head of marginal gains sweating the small stuff down as far as hand washing and the right pillows.
The thing about all our Olympic winners – from Sir Chris Hoy, to Danny Boyle, to my gamesmaker friend, Carol – is that they had clear goals, and all their efforts, big and small, were aligned towards meeting them.
Now take the NHS. I once worked there and it felt like being inside a big political football. Just when you thought you were heading in one direction, you were bounced off by a new target. You would start to get your bearings and then, thwack, you couldn’t see which goal you were heading for or which way was up.
So what is the way forward from here? Well, we know the main goal –: good quality, safe care focused on the needs of patients and their families. What we need now is eyes back on it that goal and to be resolute – Dave Brailsford-like – in driving towards it.
Robert Francis said listen to patients. That’s not only the right thing to do, it is also the way to know you are on target. Set up good quality systems of feedback and make sure every tier of management sees it. They’ll know instantly know if they are on track or not. Even better, they will have powerful intelligence to help them shine at their jobs.
There is more patients can do to help save the NHS. Many want to be in control of their own care and to share in the decisions and management of their condition. All they need is support with the right input at the right time. Enable this to happen and the focus on patients will start to flow.
And then you need to add good management into the mix. That’s about ensuring everyone’s performance indicators point towards the goal. And it’s about evaluating people on their contribution towards this. And it means taking responsibility and being honest. No more hiding.
A legal duty of candour will also help also drive culture change. What’s that I hear, a note of fear? Yes, fear is rife in the NHS – fear and nervousness. So what are we going to do about it? Doing the right thing requires confidence. Being confident means knowing you’ll get support for doing the right thing, including owning up when things go wrong. And that’s goes back to good management. And that takes us on to leadership.
Leaders, there something we often forget that can help deal with fear and that is: inspiration. Great leaders show people the possible, get them excited about the way forward. We need more of this. When I joined the NHS, I was sent on a two day induction. There we learned a lot about hygiene and health and safety and we learned about things to avoid – bugs, bad backs and litigation. Important stuff, but I couldn’t understand why no one mentioned the exciting side of our jobs. It would have taken only 10 minutes to say: “You have joined one of the most important institutions in the UK. It has been saving lives and improving them for 60 years. OK, we may not be perfect, but people will lie down in the streets to save the NHS. Now you are part of it and, together, we have a chance to make it better.” Sadly, my fellow inductees and I came away feeling nervous when we wanted to feel proud and inspired.
It would be easy to give the NHS an inspiration injection and it would cost little. It is simply about letting loose those inspirational people – and they are working at all levels of the NHS.
Get them and others like them among the troops to infect people with their energy and enthusiasm. This, combined with a serious focus on the service user, and effort aligned with goals, will start to change the culture.
Jules Acton is Director of Engagement & Membership at National Voices