Prof Rebecca Lawton paper quoted in Roy Lilley’s Blog

News and Comment from Roy Lilley

It’s late. I’ve lost track of the time. There’s just me, a white screen and a pool of orange light from the desk lamp. A glass of Penderyn sits, its amber refraction dancing across the papers.

The processor is humming; the only other noises come from the strange creaks that homes make when they are settling down for the night.

It’s funny how loud a keyboard sounds when there is no other noise. Clickety-clack, the tattoo from the backspace and the full stop ending the polyrhythm with a flourish. I feel obliged to type quietly. I don’t know why; there is only me here.

Actually, what I really want to do is to hammer the keyboard. Stab the life out of it. I want to type a huge big loudYESSSSSSSSSSSSSSSSSS!

At last there is a word that may be making a comeback in the health lexicon. A word we all might get used to typing. The word is SUCCESS. Speaking at the HSJ’s lecture evening Tarzan said his officials will create a ‘success regime to help struggling Trusts.

Wow… my fingers have frozen.

Success and failure are two sides of the same coin but they have very different currencies. Tarzan is a manager’s manager and ‘gets’ the difference. There are sound, technical reasons and the difference is important.

If the NHS is truly in pursuit of excellence then we have to understand failure. Why things go wrong. Properly understand. Technically called root-cause-analysis.   It can be tedious, methodical; search and sort. Takes ages. More important; fixing the problem, in the disaggregated NHS, doesn’t guarantee preventing it occurring elsewhere.

For as long as I can remember the NHS has focused on error detection, punishment, bungs and bullying to scrape problems off its shoes.

Technically getting stuff wrong is called negative deviance.  That’s what the NHS looks for. Focus on ND… what has gone wrong. We don’t ask what happened and why, we ask who did it. In consequence, people who make mistakes and errors will try and hide them for fear of sanction, embarrassment at being called a failure and for fear of the beatings that follow!

It takes forever and a fortune to unearth mistakes and dig them out. You’ll be like the man with a metal detector on Chesil Beach. Where to start? You’ll have no idea where to look until errors pop up and then it is too late. No one likes to admit they made a mistake. Particularly if a nightmare of sanctions and disapprobation is to follow.

There is another way, the obverse of the coin; positive deviance. Bradley et al, Marra’s study and this neat up sum from Lawton and friends describe building on success;

Identifying role models with demonstrable strategies to tackle common problems’.

People are sometimes willing to share their successes, hence they are easier to find. Just ask. However, in a repressive environment (like today’s NHS) people would rather keep their heads down and go unnoticed.

Remember what happened to The Watford CEO, Sam Jones, on the night she won the HSJ CEx of the Year award? The next morning the CQC turned up with its army to find reasons she wasn’t that good after all.

I’m pretty sure Tarzan gets all that.

The NHS has no way of finding success and is fearful of boasting about it. There is no central, easily accessible repository of good stuff. No one knows what good looks like.

When we do find what we like the NHS is hopeless at diffusingit, sharing it, widely. Everett Rogers tells us how to do it across one organisation but not across 400 hospitals with a ‘not invented here’ mentality.

It is worrying that we haven’t yet figured out a way to analyse complaints NHS-wide. I find even more worrying we don’t get close to even counting the compliments.

If we spent as much time on celebrating success as we do crowing over failure the NHS might be a better place.

The Penderyn is still there. A jumbo jet rumbles across the night sky.  The processor has whirred into silence. The desk lamp clicked off.

 Success regimes… I’ll drink to that.


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