Viewpoint: 'The lived experience of service users should be the guiding principle'

The Heisenberg uncertainty principle implies that the most useful measurements are best made not of individual components of a system but of the system as whole. Indeed, the more precisely one property is known, the less precisely the other one of a pair can be known.

Wise leaders respect targets, but are not saturated in them

How does this translate into the NHS? As Chairman Mao once said, “Of all things in the world, people are the most important”. It is a self-evident truth that has a curious tendency to get persistently ignored, even in a public service whose motto is to put the patient first.

The danger is that if we focus too much on other aspects of the NHS - however, desirable they may be in themselves - we start to lose focus on the most important thing of all: the patient.

Nobody disagrees that the service exists for the sole purpose of trying to get the best outcome for the health and wellbeing of the patient/citizen. It does not matter to its users just how the NHS achieves this goal as long as it gets there. And measuring little bits of the system may be less useful than looking at the overall impact of the system on the patient.

Exemplary leadership, outstanding clinical expertise, best management practice, perfect internal and external communications - and not just great staff engagement - are all vital ingredients of a high performing organisation. But they are not separable factors in determining its ability to deliver great results.

It is no good trying to make an inventory of these determinants and then set about measuring the efficacy of its parts. A focus on one blurs the others. More crucially, it cloaks the articulated nature of these determinants.

Organisations are like societies in miniature - communitarian in concept, not simply aggregative. They are greater than the sum of their parts. Their richness and complexity is not captured by lists of measurements against isolated, itemised targets.

In an organisation that is working well every member assumes responsibility for the system as a whole. An obsessive attention to detail atomises the organisation and reduces its capacity to function as an integrated whole.

There is also the danger that successes in some areas mask an overall failure to deliver. It is possible to imagine an NHS body that has worked hard on its staff engagement strategy, hitting all its targets, and yet remains unable to shift its long standing poor patient experience levels.

Would it be fair to judge the leaders of that organisation as having succeeded, if the main aim of the service has not been achieved?

Wise leaders respect targets, but are not saturated in them. They can set statistical evidence, collected over many years, against qualitative data and impressionistic analysis. Calibrations and numerical tables take their rightful place alongside narratives.

The lived experience of service users becomes the guiding principle.

The more leadership keeps sight of the NHS’s noble end and does not get distracted by mundane means, the quicker the NHS will deliver great patient outcomes every time.