ECRI Institute, one of the leading patient safety and medical technology research organizations, places health technology cybersecurity at the top of its just-released 2019 Top 10 Health Technology Hazards.
Patient inclusion is at the heart of wellbeing
You will always know you are on an Academy programme because the first thing you will have is an interaction with patients and carers. This was the pledge we made at our programmes’ outset before they were designed and long before they were ever delivered to a single participant. This was our pledge, and this is what we have tried hard to deliver.
True involvement of patients and carers are not just about our programmes it is about our way of being. Patient wellbeing and making patients feel safe can arise from bad working environments or the lack of training and support for staff and that’s how we help.
The better we understand our patients, the better the NHS works for them. That’s how we know that everything we do for our leaders is the right reason. Without being close to the beneficiaries, our leaders can’t do their jobs. That’s why patients have always been integral to our design. They are continually involved in our programme delivery. They are part of our validating board, sit on our strategic advisory board, and are participants on our programmes including Nye Bevan - the leading leadership development programme for aspirant directors.
Person first, patient second
Four themes have been embedded in the work of the delivery of our programmes. These are: remembering person first, patient second; for true involvement individuals need Elevation – an equal presence with the programme facilitators; ensuring dignity – that professionals see beyond the condition to the individual person; and reward – material or in kind – but true recognition for their contribution.
This also shows our commitment to one of the recommendations of the Berwick review which says that: “Patients and their carers should be represented throughout the governance structures of NHS-funded healthcare providers, for example by sitting on and actively participating in safety and quality committees.” We encourage engagement with full patient and carer membership on governing boards and on panels that hold boards to account. The review concludes: “Patients and carers should be given appropriate support and training to take a full part in these structures, to understand safety science, and to contribute meaningfully”.
Within the Academy, patients and participants sit together on all of the wider programme governance committees and their contribution is full.
We wanted patients to tell us what they think so we could really make a positive difference to the way patient care was delivered in the NHS. Getting this information and delivering it in the right way shaped our thinking and encouraged us to go and seek what great engagement looked like.
We worked closely with National Voices, a patient charity, and augmented their invaluable expertise with ongoing gathering of additional information which continues to the present day. From this work we were able to define four patient-centred leadership principles run through all of work. Firstly this includes making person-centred co-ordinated care happen. Providing a rich perspective on the needs of the patients, exploring how patients, service users, carers and families can be involved in developing better and more joined-up services, can ensure that care is enhanced to the person involved.
Secondly, it is important to create a culture for quality. A vital part of leadership is creating a workplace culture that encourages the workforce to give their best. When the workforce feels valued and respected in their working environment, they are able in turn to help patients, users and carers feel valued and respected.
Additionally, improving the quality of the patient experience is essential. Programmes explore what it means to provide a positive, respectful and compassionate care experience for patients, carers, service users and families, as part of delivering safe and effective care. This includes holding others to account and effectively challenging those practices or circumstances which might compromise these priorities.
Finally, understanding self to improve the quality of care. Working in health or social care can evoke strong emotions; care staff may struggle to balance compassion and empathy with more disturbing emotions in response to dealing with vulnerable or suffering patients. Defining an individual’s values, behaviours and optimal working methods is essential to develop strong leaders who can engage with the complex emotional life of care-providing workplaces.
Nye Bevan Programme
As patients provide a unique dimension to healthcare education, two of our professional leadership programmes – Nye Bevan and Elizabeth Garrett Anderson – were co-created with National Voices to ensure a deep focus on the patient experience that challenges our participants at every stage and improves their ability to deliver care to those we serve.
For example, on our Nye Bevan programme participants and patients meet as equals. Participants learn first-hand about experience of care. Bevan connects participants, some of whom do not have any direct patient contact in their roles, to the core purpose of improving care and services for patients. This is followed by an in-depth exploration of power, inclusion and diversity, looking at power balances, personal bias and factors within participants that may affect their ability to provide care.
Theresa Stern, patient volunteer, said: “I think it’s really important for patients to be involved in the NHS Leadership Academy programmes because I have observed that the feedback from patients made participants from the Nye Bevan programme stop and think about the real reasons behind working in the NHS – which is integrating a patient centred approach and providing quality care.”
One of the outcomes from Bevan includes the participant’s ability to create the right conditions for frontline staff, irrespective of their background to deliver good quality, patient-centred, co-ordinated and cost‑effective care is vital. Within this outcome, participants demonstrate their understanding of inclusion and issues of power, and the benefits of a diverse workforce, and their ability to challenge existing power imbalances.
The Nye Bevan programme ensures participants have the ability to engage with patients, service users, carers and families of all backgrounds, and use this perspective to foster person-centred care in a complex environment. Patients are integral to the ‘Making a case for change’ simulation where they challenge participants in their decision making.
At the end of Bevan, alongside NHS staff, patients are charged with assessing the final presentations where participants must answer to the staff and patients face to face about how they have improved patient care and staff engagement as a result of their experiences on the programme.
Theresa Stern says, she has seen this first hand on the viva panel where towards the end of the Bevan programme people had to describe the impact it has had on them. It was not just about how Bevan made a difference to them as a leader of staff, but how it is making a difference to patients.
For example, rather than getting defensive by the complaints from patients, one of the participants introduced a system so that they can investigate and talk to actual people who complained – not just say ‘we are sorry, how can we help you?’, but say ‘we are sorry and how can we can stop this from happening again’ which has made a profound impact to their service.
Patients are at the centre of everything we do and we offer patients an opportunity to undertake our new Edward Jenner programme, totally free of charge and access the learning as part of a community on our Memberships platform. Patients who have found and completed this course without any specific publicity from the NHS Leadership Academy have posted positive comments in the learner forums.
We are committed to patient involvement and the improvement of care and services. We believe we can only do our job if we remain individually, collectively and organisationally rooted in the core purpose of what we do – improving care for patients, through more engaged staff, through better leadership. We are lucky to have learnt from and with some exceptional patient leaders and will continue to do so. Our commitment is ongoing and we are always looking to improve and constantly welcome patients to share their experiences of us so we can help make a difference within healthcare.