What's possible?

Jim starts talking about what’s possible in The NHS versus what’s often accepted as passable, usually dictated by regulation. He describes what’s possible outside medicine in Alcoa, the safest organization in the world, where you would have to work for 2000 years before you lost a day at work due to a serious injury at work.  Similarly, at Well Star Hospital in The US, serious infections have been reduced from 15 to 1 to 2 per year saving 120 lives.

Stephen Ramsden, talks about what’s possible at his hospital in The NHS. He shows how they have dramatically reduced their hospital mortality rate, predominantly by reducing cardiac arest rates. The focus of this project was on improving care of the deteriorating patients.

Jim points out how many of these programmes started with an attitude of what’s passable but end with a philosophy of what’s possible. Jim describes the difference between what’s passable on an individual level, meeting requirements and keeping your job, as opposed to what’s possible, which is about daring, learning and reaching. At an organizational level what’s passable is ticking the boxes and staying in business, whilst what’s possible is about taking the risk of aiming high, which as a leader can be a big risk, also about growth, innovation and change. At a national health care level what’s passable is about getting re-elected whilst achieving the possible is about making history. He draws the analogy to mountain climbing - and a reach stone or hand grip which is out of sight but which you need to have courage and faith to go for often reaching a point of no return.

Jim highlights his 7 leverage points (what it takes to achieve your goal of moving from what’s passable ot what’s possible): the first is about setting ambition and goals which you might not reach, building an executable strategy to achieve thes aims, channels of leadership to your aims, getting patients and families on your team, engaging the CFO in aims, engaging physicians in the aims, and building the improvement capability to achieve aims.

Stephen highlights this on a national level with the NHS National Patient Safety First Campaign. This has 95% of Hospitals in The UK signed up to an aim for no avoidable deaths or harm.

Both stress over and over again that the boards work is about paying attention and seeing the problem. The Boards need to keep asking are we on track to achieving our aim of eg halving paitent harm. Stephen points out that just at his hospital if they can achieve their target SMR of 70 they could save 670 lives. Stephen highlights the power of having the personal patient or family story at the board meeting by the family, of starting every board meeting with safety items and of dedicating at least 25% of the board meeting time to safety items. He stresses the importance of getting out and about as directors, including the finance directors and about asking staff on the ward what problems they are going to face on this shift.

Leaders need to take personal responsibility for harm, which was the model at Alcoa. Stephen talks about how after listening to a group of patients he went back to his office and wrote on his white board - "stop killing patients". Stephen goes on to talk about long lasting leaders, not being macho men, but rather having personal humility and professional will - and absolute resolution to achieve goal.

Successful leaders channel attention to safety and publicly show data. they are out there showing they care about safety. He shows the value of presenting data as individual patients rather than as graphs.

Paul O’ Neil at Alcoa lived by safety being a core value, not a strategy for business success. He said "Any person who brings me an analysis of how much we save by improving safety will be fired". He didn’t want anyone wasting time on this issue. Other examples of this approach are Well Star Healthcare where they suspended 58 doctors who didn’t achieve their safety training on the day of the deadline they set.

Jim ends by stressing that success ultimately depends on building cultural capability. If you don’t have this, the rest counts for very little. Paul O’Neil at Alcoa when asked what makes for a great organization said, it’s one where everyone can say, every day, I am treated with respect by every person..., and I have the opportunity to do something meaningful ..., and when I do, somebody notices. That is the true marker of what’s possible.