Wednesday 16 December 2015

Secrecy and not-learning in the health service

Here is an interesting article on a report which somewhat condemns the level of organisational learning culture in the UK health service.

The health services should be fertile fields for knowledge management given that it is a knowledge-intensive organisation with lives at stake, and yet KM seems not yet to have made the breakthroughs that we might expect. The report quoted above suggests that an unwillingness to review and learn from mistakes may be partly at the heart of this failure.

To an extent, I can understand why. The health service in the UK, being a public sector body, is a favourite target for the media, and for a hospital or local health trust to admit publicly to a mistake invites press outrage. However without a review of failure, as well as a review of success, then there is danger to the service and to the patients of not learning. 

According to the report, the level of internal learning review is poor; as follows

  • (Health) trusts missed failings in 73 per cent of cases where [external review] found them. 
  •  Some 41 per cent of complainants were given inadequate explanations for what went wrong and why
  • A huge disconnect was also highlighted between the reality of the situation, as outlined above, and the perception of NHS complaints managers – with 91 per cent of them saying they were confident an investigation would find out what was wrong
  • In almost a fifth of investigations medical records, statements and interviews were missing.
  • A huge problem is a lack of structure, training and support around investigations. 
  • Contributing to the problem is also a lack of a national accredited training programme to support investigators or complaints staff.
The report blames cultural issues; lack of respect; not having protected time to investigate; and a lack of an open and honest culture as the primary reasons for failure, but also concludes as follows;

 “Learning from investigations appears to be trapped in high level meetings; and learning across organisations often relies on goodwill and personalities rather than any established processes or mechanisms. Our advisory group reported that cross organisational learning tends to be led by the willing few rather than something that is a widespread practice across the NHS.”

This is a description of an organisation where KM and learning is an "extra" - not something embedded in normal process, but tagged on in the form of high level and external investigations.  The bad news is that, as a result, the organisation is not learning as it should.

The good news is that this is fixable, though embedding an effective review and lesson learning framework. Once this is in place at all levels, the culture change will follow.

1 comment:

John Heminsley said...

I keep screaming at the radio and television every time such an item appears concerning the NHS! I remain unconvinced that they have any kind of system of identifying what goes well and badly. It seems almost a lost cause, fuelled by political short termism, to suppress any bad news. I just dont think that they have the appetite to address this as they are being pulled in so many other directions. Room for so much improvement and continual prodding.

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