The basic humanity of everyone receiving care must always be remembered as reform takes shape, according to the senior executive tasked with reforming the Northern Health and Social Care Trust.
Mary Hinds is Director of Turnaround at the Northern Health and Social Care Trust. She took up the post last May and was previously Director of Nursing and Allied Health Professions in the Public Health Agency.
Chief Executive Sean Donaghy had stepped aside after a series of crises. Hinds is leading the improvement programme in the Antrim and Causeway hospitals and the related community services. Paul Cummings, the Health and Social Care Board’s Deputy Chief Executive, was appointed Senior Director of Corporate Management, to oversee the rest of the trust’s operations.
“We cannot keep lurching for crisis to crisis,” Hinds told agendaNi’s Public Sector Reform Conference. “We need to plan to change and we need to plan to change in an ordered way.” The Health Service had to ensure that “we do not lose sight of humanity” in the search for efficiency.
“Each person that comes across our door is a human being,” Hinds said, “not a widget, not a process and not a target.” To go back to first principles, Robert Francis QC (head of the Mid Staffs inquiry) had described the basics of public service i.e. to protect the public and instil confidence in services.
She continued: “That’s why we’re here. I’m a registered nurse. My first duty is to protect the public in everything I do but as a leader of a health service, it is my job to instil confidence in our public services.” The same principles applied across all other public services.
Hinds is supported by a team of three colleagues and their work follows on from a review by NHS Cumbria Chief Executive Sue Page. The review looked at clinical outcomes, the trust’s performance against national indicators, whether patients felt safe, how much they were caring for their own health and well-being, the quality of clinical care, and the quality of engagement with staff.
“Do leaders recognise good from bad?” Hinds asked. “That seems very fundamental in care but that’s an issue in the Francis inquiry … the leaders took reassurance from the good but failed to attack the bad.”
One key issue was how an organisation deals with individuals who are not prepared to change. Some other pertinent questions: “Is the organisation action-orientated? Do meetings work or do they become talking shops? Do the executive and the board members work well together? Is there one culture? Does communication work? Does the trust offer solutions and not excuses?”
User demand is neither linear nor totally unpredictable. There is “a science behind patient flows” and therefore problems cannot be simply solved by working harder.
Vague wording does not help: “Some is not a number. Soon is not a time.” Numbers, evidence and timescales were needed to deliver change.
The Northern trust has a single plan and it started work with its staff. “Without them, there is no reform,” she said. “It’s absolutely vital that the staff, in the roles that they fulfil, have a sense of meaning and engagement.”
Staff need to know that their work “connects with others” rather than being limited to a silo: “When you value difference, you gain respect, you mature relationships and you build trust – and therefore you can support change.”
Hospitals are “communities of practitioners” who go through good and bad times together. She thinks that over a series of reorganisations, reform leaders have not invested enough time and effort to maintain those communities.
Staff also need to know that their work “contributes to the greater good” and she keeps reminding staff that “your 15 minutes counts” to every single patient.
The turnaround team looked at the various stages of the patient journey and asked what was in the patient’s best interests. This could mean creating new “doors” for GPs referring people to diagnostic and assessment services rather than just channelling people into A&E.
In summary, if a person does not need acute care they should not be in hospital.
Each day has to count when an acute patient receives care in hospital. Patients need to be prepared for leaving hospital rather than everything being left to the last minute. Staff need to appreciate that people in work cannot collect an elderly parent until about 5pm on the day of the discharge.
Hinds remarked: “People can be inspired to reach stretching goals and tackle impossible outcomes if they care about the outcome.” In turning the trust around, the leaders give and seek “radical honesty.” She added: “We don’t spin and we don’t stretch, and we dispense forgiveness in equal measure as challenge.”
“Reform is tiring,” she added. “You need to be able to persist.” That said, managers had “no right” to talk about being tired until they had put themselves in the shoes of someone who had sat with a child all night, wondering if they would wake up in the morning, or a father who holds down three jobs just to feed his family.
Explaining the plan, Hinds affirmed: “It is not the words that make the difference. It is the conversation and that’s what we have done. We have gone out and had a conversation with the organisation and helped them talk to each other.”
Good values form a “rock in the storm” for an organisation: “Talking to your staff about your values can be engaging and empowering. You become united by a shared purpose which reinforces teamwork and collaboration.”
Hinds continued: “The urgent cannot crowd out the important. We have reduced complexity and measured the impact. If it doesn’t work, we stop doing it and we try and do something else.”
Targets were not everything. For example, a pregnant woman who goes into a breach birth should be treated in a single room but if a room is not available, they should be treated where they are.
“There’s a new frontier out there and we’re in the middle of it, whether we seek it or not,” Hinds said in conclusion. “It is a frontier that balances cost with quality, output with outcome, targets with experience and beyond that, the frontier that is unchartered territories of science, technology, ignorance, prejudice, continued poverty and inequality in our system of care.”
There was “no reform without total reform” and “we cannot reform one bit of the system without reforming all of the system.” It was a matter of starting with what an organisation’s people have and building on what they know. Hinds paid a warm tribute to her staff: “Whether at the front line or the back office of the Northern trust, they are quite amazing.”