BMJ 2015;350:h704 doi: 10.1136/bmj.h704 (Published 12 February 2015)
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Views & Reviews
VIEWS & REVIEWS IF I RULED THE NHS
Support doctors who lead change programmes Ruth Carnall managing partner, Carnall Farrar, and former chief executive, NHS London Everyone agrees that the NHS needs “transformational change” and more “clinical leadership.” Yet to many doctors the processes that purport to support and approve major change consist of a mountain of bureaucracy focused on political risk avoidance. Continually saying, “Yes, we will support this if you can only produce this further proof,” creates more and more hurdles, hindering change. It results in doctors who have led change programmes having to act like circus animals performing meaningless tricks and then being told that their act is not good enough. So in my benign dictatorship I would insist on “yes” meaning “Yes, we will turn all our efforts to supporting you,” while “no” responses would be based on evidence, explained clearly, delivered early, and accompanied by support to deal with the consequences.
Let’s assume instead that the real world continues, with yet more assurance processes, tests, inspections, and regulations. I firmly believe that it remains possible to make radical change in the NHS. Doctors can effectively articulate a powerful case for change that, while based on evidence, also has emotional resonance. This means being honest about unacceptable or unsustainable care. There are good examples: doctors have presented data on unnecessary deaths from strokes; they have demonstrated that people are more likely to die in some hospitals if admitted at nights or weekends; and they have explained how hundreds of people with diabetes lost their limbs unnecessarily because of inadequate care out of hospital. Such statements demand action and condemn inaction. Doctors who lead change may experience huge personal exposure and are often attacked by colleagues, by their organisations, and in their communities;
and then if they are still standing the process described as “assurance” can finally beat them. Is it any wonder many give up at this point?
At present, almost every doctor faces a continual stream of patients in need. How can we make it possible for doctors to lead change? Firstly, we should recognise that we handle change badly at the moment and that we will need to provide more support and more resources. NHS England’s chief executive, Simon Stevens, endorsed this in his Five Year Forward View. Can it be followed through? We need to assess cases for change, leadership commitment, and capability, and if the answer is “yes” then we should back it with everything we have got. Exposing doctors to leadership early on is crucial. The Prepare to Lead scheme for junior doctors in London was massively oversubscribed but has now run out of funding. We can and should provide real training, coaching, and mentoring to doctors who are willing to be leaders. But most of all we need an honest discussion about which of the compelling cases where change is needed we are going to back, and then we need to say, “Yes, we will support you”—and mean it. Competing interests: I have read and understood BMJ’s policy on declaration of interests and declare the following interests: None. Provenance and peer review: Commissioned; not externally peer reviewed. Cite this as: BMJ 2015;350:h704 © BMJ Publishing Group Ltd 2015
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Views & Reviews
VIEWS & REVIEWS IF I RULED THE NHS
Support doctors who lead change programmes Ruth Carnall managing partner, Carnall Farrar, and former chief executive, NHS London Everyone agrees that the NHS needs “transformational change” and more “clinical leadership.” Yet to many doctors the processes that purport to support and approve major change consist of a mountain of bureaucracy focused on political risk avoidance. Continually saying, “Yes, we will support this if you can only produce this further proof,” creates more and more hurdles, hindering change. It results in doctors who have led change programmes having to act like circus animals performing meaningless tricks and then being told that their act is not good enough. So in my benign dictatorship I would insist on “yes” meaning “Yes, we will turn all our efforts to supporting you,” while “no” responses would be based on evidence, explained clearly, delivered early, and accompanied by support to deal with the consequences.
Let’s assume instead that the real world continues, with yet more assurance processes, tests, inspections, and regulations. I firmly believe that it remains possible to make radical change in the NHS. Doctors can effectively articulate a powerful case for change that, while based on evidence, also has emotional resonance. This means being honest about unacceptable or unsustainable care. There are good examples: doctors have presented data on unnecessary deaths from strokes; they have demonstrated that people are more likely to die in some hospitals if admitted at nights or weekends; and they have explained how hundreds of people with diabetes lost their limbs unnecessarily because of inadequate care out of hospital. Such statements demand action and condemn inaction. Doctors who lead change may experience huge personal exposure and are often attacked by colleagues, by their organisations, and in their communities;
and then if they are still standing the process described as “assurance” can finally beat them. Is it any wonder many give up at this point?
At present, almost every doctor faces a continual stream of patients in need. How can we make it possible for doctors to lead change? Firstly, we should recognise that we handle change badly at the moment and that we will need to provide more support and more resources. NHS England’s chief executive, Simon Stevens, endorsed this in his Five Year Forward View. Can it be followed through? We need to assess cases for change, leadership commitment, and capability, and if the answer is “yes” then we should back it with everything we have got. Exposing doctors to leadership early on is crucial. The Prepare to Lead scheme for junior doctors in London was massively oversubscribed but has now run out of funding. We can and should provide real training, coaching, and mentoring to doctors who are willing to be leaders. But most of all we need an honest discussion about which of the compelling cases where change is needed we are going to back, and then we need to say, “Yes, we will support you”—and mean it. Competing interests: I have read and understood BMJ’s policy on declaration of interests and declare the following interests: None. Provenance and peer review: Commissioned; not externally peer reviewed. Cite this as: BMJ 2015;350:h704 © BMJ Publishing Group Ltd 2015
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
