In the NHS today, over one in ten hospitals has been rated as unsafe. This, rather scary statistic comes as news from The Care Quality Commission’s report on the state of healthcare and adult social care in England, which outlines that the need to improve safety is vital.
The problem, it seems, is a lack of consistent process when incidents happen. For example the Royal College of Anaesthetists reports that “small incidents often go unreported, and some have reported how even major incidents involving the death of patients, have not led, despite investigations, to any clear lessons being cascaded down to staff.”
The easy and incorrect accusation is that staff aren’t doing their job properly, and should be more vigilant. What is more likely the case is that staff simply do not know what the correct procedures are, and with the high stress environment that the NHS is in there’s little time to correct a lack of knowledge.
But this is an issue that won’t be solved by correction alone. If staff fail to learn process early on re-training them can be like pulling teeth, as you end up in a 7 stage cycle of trying to get staff to accept change (one that mimics the 7 stages of grief). It’s all about getting staff on day one, training them in processes fully and making sure that it is understood that this is the way things have to be done. Training must be provided, and it must be comprehensive and clear. The CQC’s report cites a lack of training as a reason that some areas of hospital safety are inadequate. Indeed, in the outstanding hospitals “statutory and mandatory training levels were good, with clear plans to address any gaps.” (page 48 of the CQC report)
Safety training is the only area which needs improvement however, as the report goes on to point out how inadequate services offer poor staff development and improvement. To encourage a culture whereby staff do not just rest on their laurels and instead seek to improve their abilities requires a system that supports them, and a decent training platform seems intrinsically linked to achieving this. Once again the report suggests that “Outstanding adult social care services have training programmes for staff, and a culture that encourages all staff to continuously improve.” (Page 44 of the CQC Report)
The reassuring aspect of all this doom and gloom is that it is a problem that can be tackled. Just now we’re starting to see a shift in the NHS towards adopting training systems other than the often complained about free system that was provided by the government many years ago. Places like University College London Hospitals have moved away from their proprietary platform and onto open source platforms that offer more flexibility and can be more easily controlled by the hospitals themselves. The fact that the training can be done offsite has meant that staff can take their time prior to arriving at the trust making sure they’ve completed all the training and aren’t pressured into doing it alongside their day-to-day job.
The CQC report highlights that the issue with staff training lies in the culture and access. We need to understand that properly trained staff are more valuable and reliable, and that time dedicated to training is more important than forcing a rushed job. We need to recognise the need to develop staff, and to measure developments in regular review sessions that plan out what needs improvement. In the same way that prevention is better than a cure, training is better than an accident report. The culture needs to see a shift towards supporting training, rather than sidelining it.