The Board, The Patient, The Story, and the Ritual
Dr Nadeem Moghal
Doctor - Passionate Pastist - CMIO - Director - Advisor - Coach - Mentor - Consigliere ??
A patient story starts every NHS provider Board. It is also becoming a thing with some Integrated Care Boards (ICB).
Every Trust and ICB will have a policy and a how-to guide (1). It might describe the why (2). There is no record of how this all started. It would have been some well-meaning person trying to keep the patient at the centre of the Trust’s purpose.
Presumably, this need arose because the first-ever Trust somehow forgot. It then spread like a rash - who says ideas don’t spread…
The patient’s story is sometimes positive (3) but almost always about when things go wrong, sometimes horribly wrong, then ending positively, somehow.
Perhaps the story is trying to wake up the Board on the realities of care delivery, and they must act and ensure the story is not repeated. Board members will mostly listen, waiting to say something caring and empathetic; sullen heads might even be bowed, some staring at screens, wishing in futility, the email just in is urgent enough to be excused.
Perhaps Perhaps Perhaps
Perhaps the story is there to remind Boards why they exist to do what they do—using the story to build an emotional and personal connection and motivate and spur action. If a Board needs to be reminded why it exists, might it need to ask itself some difficult questions?
Perhaps the NEDs are using the Board story as a proxy for doing the work of stepping into the organisation, speaking to patients and staff, listening, and triangulating.
Perhaps the patient story affirms the common core of every NHS Mission, Vision and Values ambition - the patient is at the centre of all they do. If that is the case, then the theatre of the patient, stranded at the Board, telling their story, is more about the drama and less about doing the work to organise services to genuinely meet patient needs.
Perhaps the story is to tell the population that the Board is listening (4). In that case, the stories are theatre and all about comms and marketing rather than whatever authentic leadership means.
Perhaps the story is designed to drive improvement; ‘you said, we did’. (5) The Board, as a driver of a case-by-case driver of improvement, is an inefficient and inappropriate distraction from the Board's purpose.
The emotional trap
The storyboard and process is now etched in stone. The Chief Nurse’s team is tasked to find the stories. A nurse will prepare the patient. They wait nervously in the corridor. The nurse will bring in the patient sometimes, with a friend or carer. The nervous patient sits before serious people in suits around a table or, more likely, ill-fitting tables gathered to fill the space. The Chair will set the frame trying to be welcoming. The nurse makes a brief introduction.
The patient tells the story. Questions are asked. Empathy is expressed. An earnest commitment is made to prevent a recurrence of the poor experience and harm. The patient is thanked. The patient and nurse leave the room. The person that controls and directs the means of production, key to that poor experience and ultimately accountable, never part of the ritual.
The Board stays solemn, shuffles papers and notebooks, keyboard clicks theme the exit. The emotional trap released.
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The Board turns to the 8kg agenda. Papers filled with holes between the Board and the layers down to the patient. The patient's story has already been forgotten.
Perhaps that’s it. The patient story is meant to cut through all those layers. Yet there is no evidence that the story makes a material difference to the Board’s strategic focus to ensure needs are understood and reliably met (6).
A view expressed by an NHS Trust NED in a room filled with NEDS described the patient story as “at best tokenistic and patronising and at worst paternalistic virtue-signalling”. The organisation is doomed if a Board needs a patient story to remind them why they exist. The NED’s opinion has been deemed an outlier.
Stopping what has now become business as usual is almost impossible; some ICBS started with this ritual, but have stopped, focusing instead on the staff. CQC rated Outstanding Trusts will use the patient's story to remind them that there is always more to do. Trusts in CQC troughs will remind everyone that they are still in the trough and that there is much more to do. No Executive will say stop this distraction because the mob will conclude you are not patient-centred. It is tough to break groupthink.
It must be in the ritual
Perhaps it's just a ritual. A ritual that is symbolic. A moment to get the Board around its purpose. A ritual that is key to getting the Board to become a community to serve the many communities. But still, only a ritual by itself does nothing to make a material scale difference.
Successful organisations focus on meeting customer and consumer needs. They invest heavily in understanding those needs and designing services and products to meet them; otherwise, they are out of business; see Kodak. Disney lives or dies on meeting the expectations and experience, understood through meaningful research and insight filled analytics, not stories at the Board. Otherwise, there is no business.
NHS organisations all have the same purpose: meeting patient and population needs. The NHS cannot go out of business. The NHS cannot fail. It does exactly that every time a need is unmet.
The patient’s story is theatre, drama, a subject getting a hearing at the court of the great and the good, a ritual.
If emotional traps and rituals are needed to remind a Board of its purpose, then the Board, a 1980’s reform, needs reform.
Dr Nadeem Moghal
19th March 2024
Note: Ai has no hand in this or any of the author's writing. Images, ok. Typos are not deliberate.
References
It's interesting to consider the potential impact of sharing patient stories in a board setting, and whether it genuinely drives meaningful change or simply serves as a symbolic gesture. How do you think boards can strike a balance between empathy and action?
Clinical Safety Officer and Care Quality Commission Lead at 8foldGovernance | U7s #RFU Rugby Coach | Assistant Cub Scout Leader
6 个月Completely agree with Julie Garrity and Sue Holden's comments - amongst others. The affective board stories I have seen are those that revolve around avoidable injuries and deaths, with some level of system failure. But only when the board understand why they are hearing the story and the resulting actions. Outside of the purpose for the Board - I do feel that they can also be incredibly valuable for the family/ individual involved. This can be an important part of them coming to terms with the initial incident. Where these stores fail, as so many others have said, is when they are a tick box - similar to any activity that is treated as a tick box. It also fails when used in isolation - there is a risk one off stories drive policy and practice change, without corroborating holistic evidence. It would be great to see Boards also reflecting on positive stories. If Board members want to understand their organisation they need to get out into the functional parts of the organisation to speak to staff and patients. Again though there should be clear expectations, reflections and discussion. Board's can be like any other group of staff - reluctant to fully commit to ideas and work streams that do not serve short term interests.
Very interesting. Food for thought
None
8 个月Patient stories were introduced by Sheelagh Machin within the heart team of the modernisation agency. It was a very deliberate means to identify the difference between the clinical teams perspective and that of the patient or carer. When done well it is very powerful and enlightening for clinical staff.
Patient Experience and Improvement Lead at Leicestershire Partnership NHS Trust
8 个月Really interesting article. For me, I have mixed feelings about this approach, often stories are very carefully selected, can feel very staged. Voices at every level of governance and decision making in an organisation can go a long way in terms of placing the patient, carer or family voice at the centre of the Boards/Trusts business. Stories are a gift for learning, education and more importantly improving. They need to be hardwired through all elements of decision making.