One of the biggest questions facing every nation is how to maintain healthcare systems using stretched resources while caring for an increasingly ageing population. For many countries, simply maintaining the status quo in quality of care is a massive achievement.
But to improve the quality of care it’s crucial that leaders know how they link improvement to the financial pressures, so improvement becomes the best way to reduce costs.
Recently I was delighted to be invited by Healthcare Improvement Scotland to work with some of the most senior leaders across all the NHS boards in Scotland as part of a masterclass on leading for improvement.
Although it’s true that in any large system things go wrong, the healthcare leaders in this country have achieved some stunning successes in improving patient safety, particularly around surgical survival rates, post-operative complication rates, reduction of acquired infections and pressure ulcers. These are carefully measured improvements that could stand up as benchmarks for success for any country.
When things do go wrong, we need a quality control system, such as inspections. It’s like fixing a flat tyre on a car. You can’t progress without it being fixed. But it’s important that that is not all that’s happening. You need to create an environment in which continual improvement is everyone’s job and each year people can count on living longer and having few complications in their healthcare. That pairing of the quality control function with the improvement function is what’s so unique in Scotland.
The Scottish Patient Safety Programme (SPSP) is just one example of the real joined-up thinking that is leading the way to constant improvement. From an initial focus on acute hospitals, their work now includes safety improvement programmes for acute adult, healthcare associated Infections, maternity and children, medicines, mental health and primary care. The reality is that Scotland is the internationally leading success story of healthcare safety improvement. Other nations have made progress, but not to the degree of comprehensiveness – and, I think, scientific discipline – that Scotland has.
The innovations and lessons learned across healthcare improvement are now being applied to social care. Taking these competencies and moving them to the larger picture of health and social care integration is a bold move and one that is unmatched globally.
Part of this new approach is putting the patient’s voice at the centre of care. There’s a global trend now for a real empowered patient voice. Many countries are on that journey – but again Scotland is ahead of the curve and leading the way in a much more invitational system for people to speak up about their care to make the system better.
It’s clear to me that Scotland, compared to other nations, should be extremely proud of what it has done with the improvement of healthcare, and extremely excited about what it can do if it sticks with the ambition to make this country the healthiest one in the world.
Improvement is a continual journey and new challenges will always arise. But Scotland’s track record and history of leadership commitment gives me confidence that it is and will remain a model for others to look to.
Professor Don Berwick is President Emeritus and Senior Fellow, Institute for Healthcare Improvement.