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CSC’s Healthcare Group

Health IT and the Francis Report

Dr Paul Shannon30th April 2014

How IT systems can help

address the key findings of

the Francis report

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What is ‘culture’?

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Schein’s 3-layers model

• Schein, E.H. (1985) Organizational Culture and Leadership, Jossey-Boss, San Francisco, CA.

Surface manifestationsArtefacts, ceremonies, rituals, heroes, sagas, etc

Values and Beliefs

Basic assumptionse.g. nature of reality, truth, relationships

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Analysis of cultural diversity in a NHS Trust using Schein’s 3 level scheme

(sub)cultureLevel 1Surface

manifestations

Level 2Values, beliefs

Level 3Basic

assumptions

Medical White coats, stethoscopes, ritualised ward

rounds, fellowships of Royal colleges,

eminent personalities

Personal contract between doctor

and patient, clinical freedom,

scientific basis for treatment, member of

profession, not employee of Trust

Hippocratic Oath, patient

confidentiality, sanctity of life,

responsibility to patient

Admin/Managerial

“civilian” clothes, plush offices

remote from patient areas, separate

hierarchy

Loyalty to Trust,Resources limited by

centrally controlled

budgets, Financial prudence,

adherence to central policy

Responsibility to Trust/NHS for public money expenditure, health gain of

population more important than

individuals

Nursing Uniforms, “hands-on” work,

Largely female, local training

Patient advocacy, care more than cure, nurturing, comfort, self-

sacrifice, hygiene

Primacy of the individual,

patient dignity,

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‘...doing the right thing even when no-one is watching’ (C S Lewis)

Key finding: ‘Secrecy’

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Key finding: ‘A lack of openness to criticism’

‘To focus on blame will perpetuate the cycle of defensiveness, concealment, lessons not being identified and further harm.’

(p35, Executive Summary)

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Key finding: ‘Acceptance of poor standards’

Urgent improvement necessary

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Key finding: ‘Misplaced assumptions about the judgements and actions of others’

There should be ‘...no place for favourable assumptions’. (p1678)

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Key finding: ‘Defensiveness’

“We can only be sure to improve what we can actually measure.” (Lord Darzi)

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Key finding: ‘Looking inwards not outwards’

‘[The NHS] is self-referencing. It’s not good at listening’ (Ombudsman, p1363)

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Key finding: ‘A failure to put the patient first in everything’

‘The Trust prioritised its finances and its FT application over its quality of care, and failed to put patients at the centre of its work’. (p45, Executive Summary)

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Conclusion

• Patient stories have high impact!

‘a rich and varied source of information on each patient to help patients avoid or manage chronic disease, deliver truly personalised health care

and proactively monitor safety and quality of care.’ (CSC, 2012)