Don Berwick leads on the report to improve the safety of patients in England:

Roy Lilley leads on the criticism of its contents: Stating he “hates its lack of grit and traction, and failure to take on the real issues”, and that Berwick has “tried to be too clever by half and the result is a report that only half deals with the solutions”.

Roy Lilley has to be congratulated for adding to the stimulus to read Don Berwick’s report in detail – I’m sure I and many others wouldn’t have made this a priority task in a busy week.

His key criticisms amounted to what the report didn’t say. According to Lilley, it didn’t say:
– Protect the front line – fund it properly, protect it fiercely, mandate its staffing and make it fun to work there.
– Make all Board members apply and qualify for a license to hold public office.
– Regulate HCAs.
– Dump the lunacy of Monitor and the CQC.
– Be honest about the money thing and how to get more for no more.
– Reorganisation has got you into this mess and you won’t reorganise your way out of it but you can unpick it, carefully.

So what do the Berwick recommendations, say?

These can be summarised and grouped in key themes as follows:

Strategic priority
NHS healthcare leaders should place quality of care and patient safety, at the top of their priorities for everything.

Learning
The NHS leaders should create and support the capacity for learning and the NHS should embrace an ethic of learning. Mastery of quality and patient safety sciences and practices should permeate all education thinking and practice.

Community engagement
Patients and carers should have influence at all levels of healthcare organisations. All organisations should seek out the patient and carer voice to monitor the safety and quality of care.

Staffing
All parties should assure sufficient staff are available to meet the NHS’s needs now and in the future. Healthcare organisations should ensure appropriate numbers of well-supported staff are present to provide safe care at all times.

Monitoring and control Systems
Transparency should be unequivocal. All data on quality and safety should be shared in a timely fashion with all. Supervisory and regulatory systems should be simple and clear, and embrace the goodwill and sound intention of the vast majority of staff.
Regulation of organisations should be responsive and tailored. Recourse to criminal sanctions should only function as a deterrent to wilful or reckless neglect or mistreatment.

So, it if feels as if Berwick is focusing on changing culture, and Lilley is suggesting some key strategies or tactics.

In this vein, two quotes come to mind:
“Culture eats strategy for breakfast” (Peter Drucker)
“Tactics without strategy is the noise before defeat” – (attributed to Sun Tzu – an ancient Chinese military general, strategist, and philosopher)

It could therefore be argued that Berwick’s recommendations would have more impact in creating a lasting legacy on improving the safety of patients, than Lilley’s suggestions. Looking through a glass darkly, it could be represented as one playing a game of chess whilst the other plays draughts…

But, do the Berwick recommendations lack grit and traction, as Lilley asserts?
It all depends on whether those responsible for leading healthcare organisations have the ability, will and opportunity to grasp and act on the challenge to develop a culture of learning, engagement and transparency. If the ability, will or opportunity are lacking, then Berwick will have misjudged the wider context of healthcare in England, and his recommendations will indeed “only half deal with the solutions”.

But, if those responsible for leading healthcare organisations can rise, and have the opportunity to rise to this challenge, then history might show Berwick’s report as a significant line in the sand in for safety of patients in England.