Can greater transparency expose future care failures?

The government has launched a number of pre-emptive strikes in advance of the publication of the Francis inquiry’s report into Mid Staffordshire Foundation Trust. Several of these indicate that it sees transparency, particularly data transparency, as key to preventing future failures.

‘Will better public access to data mean more attention is paid to quality and the experience of patients?’

Speaking at the King’s Fund in November, the health secretary Jeremy Hunt stressed the role of better access to information and data in creating “pressure for constant, relentless improvement in standards”. Since then, he has repeatedly lauded the work of Ofsted, commissioned a “ratings review” to look into whether a composite measure of quality should be developed for hospitals and hinted that he is exploring whether data on the quality of general practice should be more readily available to patients and the public.

Earlier this month, the prime minister pledged to roll out the friends and family test across all sectors of the NHS, believing it provides an early warning to staff and managers that there may be a problem that needs looking into. In addition, the NHS Commissioning Board has committed to publishing individual consultant-level outcomes for various surgical procedures.

So, it is clear the government believes in the power of transparency. But will it prevent gross failings in care going unchallenged as they appear to have done at Mid Staffordshire? Crucially, will better public access to data mean boards pay more attention to quality and clinical teams focus on the experience of patients?

Be more engaged

There is evidence that publishing comparative data can lead organisations to pay more attention to quality, particularly those towards the bottom of any league table compiled from such data.

But this will only have the desired effect if it is accompanied by a culture change among NHS leaders. Crucially, as the King’s Fund’s leadership review found last year, the key is to develop a more engaged style of leadership.

‘There is a risk that in an effort to be seen to act, ministers will introduce more regulation in response to Francis’

First, leaders need to make sure they hear the voices of patients and carers. Listening to patients involves a range of things, including taking complaints seriously − reviewing their content as well as monitoring the number of them; routinely gathering and analysing patient feedback, not just tracking whether average scores go up or down; walking the wards; hearing the stories of individual patients and carers first-hand; involving patients in service design; and directly engaging with governors, Healthwatch and other patient groups.  

Second, leaders need to empower staff in clinical teams to speak up and take action to address problems. Team leaders must be given permission to do the right thing, even if this challenges the way things are usually done, and it is vital that all staff know how to raise concerns about the quality and safety of care, and that these concerns will be heard and acted on. This may mean identifying someone in every hospital who staff can go to outside the line management chain without fear of repercussions.

Third, boards and senior staff need to pay attention to the experience of staff, as well as the patient experience. If staff are motivated, engaged and feel valued, they are more likely to provide high quality care.

Shining a light

Many jobs in healthcare are physically and mentally challenging. Organisations need to recognise this and provide staff with opportunities to discuss their experience of care giving. Although the focus is often on nurses and healthcare assistants, quality of care should be every health professional’s business.

Finally, leaders themselves need to pay more attention to information and data. This requires them to have confidence in the quality of data, for it to be clearly presented and, particularly in the case of non-executives, to have the skills to interpret and challenge it. High performing organisations understand this means going beyond measures required for external reporting and using data proactively to drive quality improvement.

‘Fear of failure has been found to crowd out the desire and opportunity for learning’

There is a risk that in an effort to be seen to act, ministers will introduce more regulation in response to the Francis report. Regulation and external scrutiny are important.

By shining a light inside organisations, regulators can reveal both good and bad practice. Through inspection, they can go inside organisations and observe care first hand, speaking to staff, patients and carers to build up a picture of the quality of care. By requiring data to be published, they can ensure consistent and comparable information is available to patients, the public and commissioners.

But how they do this must support openness and transparency within organisations. Fear of failure has been found to crowd out the desire and opportunity for learning. Increasing external scrutiny, “naming and shaming” and more severe penalties for those found wanting are just as likely to undermine as support openness and transparency.

In responding to the report, the trick will be to align regulation and the push for greater transparency to encourage boards and leaders to develop a culture of openness within their organisations.

Anna Dixon is director of policy at the King’s Fund