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  Mary Clarke, CEO of Cognisco, responds to news that Mid Staffordshire NHS Foundation Trust has been put into administration.


Mary Clarke, CEO of Cognisco,, a specialist in people risk, assessment, management and mitigation responds to news that Mid Staffordshire NHS Foundation Trust has been put into administration and last week’s report that the NHS has set aside £17.5 billion to pay legal claims following medical blunders.

She describes a ‘people risk’ solution that is working for one of the UK’s largest NHS Trusts to reduce serious incidents and mitigate risks.

News that Mid Staffordshire NHS Foundation Trust will be put into administration after one of the worst scandals in recent years is another blow for the NHS. Health watchdog Monitor has appointed two special administrators who will start work to “safeguard the future of health services” at the NHS Foundation Trust. It was said that Mid Staffs, which was at the centre of a three-year public inquiry into “appalling standards” of care, was “neither clinically nor financially sustainable in its current form.”

This announcement follows a report last week from MPs which revealed that the NHS is facing a growing mountain of legal claims and has had to set aside £17.5 billion to pay compensation to thousands of people making clinical negligence claims. The number of claims has risen by 11 per cent in just one year, and MPs warned that the ‘inexorable rise’ may be spinning ‘out of control’.

At a time when the NHS faces severe funding issues, a significant increase in clinical negligence claims highlights the need for the NHS to reform its culture and approach to managing ‘people risks’. We all know that an organisation’s people can be its greatest asset or its biggest risk and we have seen all too clearly that medical blunders resulting from human errors can have devastating consequences – from minor injuries to deaths, as well as potentially leading to millions of pounds in compensation.

For the past three years we have worked with one of the UK’s largest NHS Trusts to help eliminate the risks of serious case incidents and deaths in Obstetrics. Last year, the NHS paid £400m in obstetrics damages. Improving patient care and eliminating the risk of serious case incidents or deaths is a priority for every NHS Trust and our project has made major progress in a specific area of risk through the introduction of a multidisciplinary assessment and training programme for midwives and clinical staff.

We have shown how significant improvements can be obtained by measuring and correlating confidence with competence and then adapting existing interventions such as ‘Skills & Drills’ training to focus on the area of greatest need or risk, particularly where it relates to the behaviour of staff.

The programme used occupational psychologists to help improve the performance of clinical teams when handling emergency situations. It also benefitted patient care and, since the programme was initiated, there has been a reduction in serious incidents. Ensuring that midwives and obstetricians are competent in the handling of complex cases and emergencies is a top priority for all NHS Trusts.

The reports on Mid Staffordshire should be a call to action for the NHS. As Robert Francis QC and Inquiry Chairman at Mid Staffs said, “the extent of the failure of the system shown in this report suggests that a fundamental cultural change is needed. This does not require a root and branch reorganisation – the system has had many of those – but it requires changes which can largely be implemented within the system that has now been created by the new reforms”.

We advocate a new approach to managing and mitigating people risks in order to reform the way people work, improving their competence and decision making under pressure and reducing the number of serious incidents. If the NHS as a whole could implement a similar programme across its multidisciplinary teams it would help to deliver cultural change, address people risks without creating a ‘blame culture’ and enable staff to reach their full potential.

The NHS’s ability to deliver high quality care across a large population and its development of world class professionals has ensured that it is a well respected brand globally. The New England Journal of Medicine said in 2009 that the NHS offered the Obama administration “important and relevant lessons”.

We now need prompt action to mitigate people risk if we are to improve the NHS’s reputation. At the same time we need to integrate the essential shared values of a common culture into the education, training and support of the key contributors to the provision of healthcare if we are to change behaviour. After all, it is far more effective to learn than to punish if we are to create a sense of collective responsibility for ensuring quality health care is delivered.

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