Quality assurance issues at Addenbrooke’s Hospital and systems thinking

Last year the quality care commission put Addenbrooke’s Hospital into special measures after their inspection. The good news is that the hospital is out of special measures and in January this year the overall rating was good.

At the time of the initial report and the placement into special measures there was an outcry as some considered the rating unfair. Death rates were comparable to most well run hospitals, patient care was good and cancer treatment outcomes were amongst the best in Europe. So what was the problem? The issue was that although clinically the performance was good, there were operational issues that meant routine operations were often being cancelled, there was a backlog in follow up clinics and resourcing was not always adequate.

The point I would make is that it isn’t good enough to be “clinically excellent”; the organisation needs to be “operationally excellent” as well.

Clinical excellence comes from having well trained and motivated staff working in their areas of expertise and delivering to high standards. By and large, doctors and medical staff can attain this on their own, but operational excellence requires wider involvement of all the staff in an organisation. It requires the systems to work. It requires coordination between different clinical groups and between administrative staff and clinical staff. It requires plans so that the demand is understood and the resources are planned for and provided. This is a different skill set and if anyone thinks hospitals don’t need hospital management they are wrong.

A lot of managers can deal with their own versions of “clinical excellence”. They can create teams of well qualified, motivated and experienced people that deliver on local goals. But the wider coordination and planning activities requires wider skills. It is not just about managing people it is about understanding operations and processes. It requires wider skills in systems thinking.

Finally, what is the role of leadership? The role of leaders is to create and manage the overall system in which everybody needs to work. They need to understand the dynamics of that system and how each part of the system interacts. They need to know how to guide that system through setting goals, measures and targets. They need to understand how the rules of the game that are created by doing this impacts on the performance of the organisation as a whole. And too often I don’t see people at the senior level who fully understand this.

Mike Bourne