Clinical Leadership: lessons from the past to help build the future
Lord Ara Darzi
Clinical leadership has been central to my values and vision of the NHS, from very early on in my career. What became apparent almost immediately when I started working was the immense knowledge and value that other healthcare professionals had in the training of all the junior doctors. It was this that drove me to set up nurse-led endoscopy clinics, and spear head nurse-prescribing. What I have always believed in, is leadership from the bottom up, as well as top down, we must rely on those who best understand the process or the system that they are leading. I believe that all healthcare professionals have the transferable skills to develop their own strong leadership style.
Throughout my career I have met incredibly smart and inspiring people and continue to do so on a daily basis. I have had the privilege of working on the front line as a surgeon, as an academic at Imperial College, as a Minister at the Department of Health, amongst many other roles. It is the talent within each of these units that continues to motivate me and gives me great confidence for the future of the NHS. These people are what keep me optimistic about the system. We continually see negative statistics about the performance of the health service, and rarely take time to appreciate its incredible achievements.
This year has been a remarkable year, we have had the honour of celebrating the 70th anniversary of the NHS. To coincide with this and for the 10th anniversary of my report ‘High Quality Care for All’, I authored a report entitled ‘Better Health and Care for all: A 10-point plan for the 2020s’. I have also had the privilege of celebrating 10 years of the Darzi Fellowship programme, and it was an incredible experience to see so many inspiring healthcare professionals who are dedicated to drive system improvements and change.
The report highlighted a discrepancy between quality indicators in the NHS such as life expectancy and rates of smoking and drinking, and people’s experience and perception in terms of their satisfaction. To explain this, we must think about how we enumerate people’s experiences. I believe satisfaction is too crude a measure to understand how people experience healthcare. We use it as a general gauge of how people feel, but ultimately it does not tell us why people feel the way they do, what we should improve, or where there was a mismatch between expectation and experience. In order to understand quality from a patient’s perspective, we need to collect information not only about what they experienced, but also what they expected. We also need to improve experience questionnaires, so they capture patient feedback in a quick and timely way with data that can be easily digested for improvement efforts.
In thinking about why clinical quality indicators go up and satisfaction metrics go down; it is important to reconsider the mismatch between expectation and experience mentioned above. In the past, the health service was mainly expected to deliver diagnostic services and acute care. Now the health service is tasked with a rising proportion of people with long term, chronic conditions impacting all aspects of life. Why is satisfaction dropping? Because the health service was not sufficiently future-proofed to deal with these new demands.
Quality indicators reflect very specific measures: mortality, quality of life, patient experience, incident reporting etc. To get to the heart of whether these reflect what patients want and need, we need to ask them. Our vision is not only to measure, but to derive measurements that are meaningful. This takes engagement with patients and the public, not just capturing the facts in hospital.
Quality improvement in the health service is an evolution. First, we become curious about whether or not something matters, then we start measuring it, then we use that data to improve. As healthcare leaders, we need to add momentum to that journey and ensure that once we have developed logical and meaningful metrics, that we make them available to the people who use them. We can inspire local ownership of quality indicators by making them accessible, but also by making sure they are not simply fed into benchmarking tables or used as regulatory sticks, which can scare organisations and threaten innovation.
One such reported measure is the decreased access to healthcare. It is a remarkable achievement that over the past decade of austerity, the quality of care has maintained or improved; however, what we have seen is a decline in access. Funding alone will unfortunately not solve this problem. We must embrace all the novel opportunities to drive change in the system, moving from a ‘diagnosis and treatment’ service to a ‘prediction and prevention’ service.
We must seize the revolution in robotics, artificial intelligence and data analytics, and use them to transform the way in which we deliver care. Access can only and will only be improved if we deliver a system that is predominantly a wellbeing service over a sickness service. Behavioural interventions, population stratification are all tools that are now readily available to us, to best enhance and improve the system.
Lord Darzi is one of the world’s leading academic surgeons who has made fundamental contributions to the quality and safety of surgery. He has pioneered technological advances involving minimally invasive and robot assisted surgery. He was knighted for his services in medicine and surgery in 2002.