Why do hospitals fail ?

 The Care Quality Commission (CGQ) have just announced that 17 NHS hospitals are included in a list of 26 providers failing to operate with safe staffing levels. London Ambulance Service is also included in the roll of shame.

http://www.bbc.co.uk/news/health-21002205
 

How do you define safe staffing levels? I have witnessed wards with plenty of staff but still failing to provide adequate care. Even more importantly – how do you define a failing hospital and why do hospitals ‘fail’? The Mid Staffs inquiry is still an open wound, reminding all concerned with healthcare of just how catastrophic the outcome of poor management and poor care can be.

The CQC has indicated that the facilities and services named in the list must ‘comply with its standards, and show how they were going to achieve this’

I must be among many who continue to be more than a little confused about to which tune a hospital must dance. The Health and Social Care Bill of 2012 strengthened Monitor’s role, defining the regulatory body’s main duty as ‘protect and promote the interests of people who use health care services by promoting the provision of services which is economic, efficient and effective, and maintains or improves the quality of services’. A classic sound bite that says everything and nothing. The document entitled ‘Introduction to Monitor’s future role’ continues… ‘our job as sector regulator will be to work with other bodies, notably the NHS Commissioning board, the Care quality Commission and NICE…’

There is an old saying which goes ‘he who pays the piper calls the tune’. But who is calling the tune for NHS hospitals? According to the House of Commons select committee, the CQC has ‘failed to grasp its primary role to ensure patient safety’

Everyone of course has their view of how care can be improved and the lack of clarity is further exacerbated by organisations such as the Royal College of Nursing. Last month Jane Cummings, Chief Nursing Officer ‘helpfully’ (in my opinion, not, actually) defined the 6 ‘values and behaviours’ to ensure good patient care– Care, Compassion, Commitment, Courage, Communication and Competence. A worthy and attractive list – but how can the six c’s be implemented and measured? Ms Cummings went on to say that patients are ‘more complex’ these days. No! Patients are not more complex! They are vulnerable human beings who need to put their trust in the clinicians and support staff who are treating them. Yes – healthcare is more complex, technology more advanced and expectations (quite rightly) higher. But patients are still just the same as they were in 1948 when the NHS started.

Back to failing hospitals. It is an uncomfortable truth that Hospitals need to be run like businesses – not necessarily from the profit perspective but certainly from a position of good management, good financial planning, positive culture and meeting the customer’s needs in a cost effective way. Why do businesses fail? Apart from start–ups where the initial idea and execution is flawed, there are four main reasons businesses go under.

1)   The financial modelling is wrong so it will always operate at a deficit. Poor cash flow will finally catch up with the business and bring it down. This can apply to Hospital Trusts

2)   The customer base dries up – either due to better or cheaper competitors or because there is no longer a requirement for the product or service (such as the recent demise of the photography retailer – Jessops. Online sales and good camera phones have changed the marketplace). I don’t think there is a danger of any hospital running out of patients although of course a facility can be over-bedded or the emphasis of services may not reflect local needs.

3)   Overtrading. The business supplies more services and products than they can profitably handle – back to cash flow. This is the equivalent of unsafe staffing levels – hospitals providing too many services with inadequate resources.

4)   Poor Leadership. Where the basics of the business are sound, but staff are underperforming, they are poorly managed and fail to deliver the required level and quality of service.

Do these all sound familiar? Of course they do. And talking about poor leadership and failure to deliver service – it is poor financial management, poor clinical leadership or poor operational leadership that can generate damaging lapses in care, quality and efficiency.

So whoever is paying, or monitoring, the piper – the tune must be the same. Strong leadership, measurable targets and tangible feedback (from patients and clinicians) is the best hope for the future of NHS hospitals.

Am I sounding a bit like a broken record?