Patient care at the Mid Staffordshire hospitals
The board of the Mid Staffordshire General Hospitals NHS Trust (the Trust) embarked on a major change programme directed towards achieving the elite status of a foundation trust. Foundation trusts have greater autonomy than other hospitals, are less dependent on government funding and have the right to borrow money from banks. In order to achieve this sought-after foundation trust status, the Trust was required to prove its financial competence, balance its books and achieve a range of government targets such as those relating to waiting times. As the push for change gathered momentum, the Trust set itself the target of £10 million savings (8% of turnover). It achieved this by pursuing a tough top-down change strategy (see Chapter 16) that involved eliminating 150 jobs, some restructuring, an 18% reduction in the number of beds and a range of other cost-cutting measures.
The Healthcare Commission, the NHS watchdog in England, became aware that death rates for patients admitted as emergencies at the Mid Staffordshire hospitals were significantly higher than at comparable hospitals and initiated an investigation. Attention was focused on the accident and emergency (A&E) department, the emergency assessment unit and the surgical and medical management of emergency admissions.
The problems that were identified are documented in the Healthcare Commission’s report (2009). Problems were found at every step along the emergency care pathway. For example:
• Because of a shortage of nurses, when patients arrived at A&E, the seriousness of their condition was assessed by a receptionist who was not clinically trained. Patients were then moved on to a reception area that was out of sight of reception staff.
• There were shortages of essential equipment such as cardiac monitors.
• Because of the shortage of doctors and nurses, assessment and treatment
were often delayed.
• Junior doctors were pressurized to make decisions quickly.
• Doctors were diverted from treating seriously ill patients to deal with more
minor conditions in order to avoid breaching the government-imposed target that 98% of patients arriving at A&E should be seen and either admitted to a ward or discharged within four hours.
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• Another tactic to ‘stop the clock’ and avoid breaching this target was to move patients out of A&E to the emergency assessment unit. Once there, because of staff shortages, they were not properly monitored.
• Nurses had high workloads, and many were under trained. Cases were reported where nurses turned equipment off because they did not know how to use it.
• Because of staff cuts there were too few consultants to supervise junior doctors.
• There were too few operating theatre sessions at weekends.
• Patients had to wait for medication, pain relief and wound dressing and
sometimes the wrong medication was administered.
• The care of post-operative patients was so poor that signs of deterioration
were missed or ignored.
• Relatives reported that patients were left for long periods in soiled
bedclothes and were left without food or drink (there were even reports of thirsty patients drinking water out of flower vases).
The top-down change strategy targeted at winning foundation trust status was successful, but only in so far as it delivered this narrowly prescribed outcome. The trust was awarded foundation status but this ‘success’ was short lived. The publication of a damming Health Commission report led to further investigations into the quality of care delivered by the Trust. The last of these was a lengthy public inquiry that led to the eventual dissolution of the Trust. The Stafford Hospital was renamed and taken over by a newly constituted NHS Trust.
Jeremy Hunt, the Minister for Health, stated in his introduction to the government’s response to the public inquiry that ‘a toxic culture was allowed to develop unchecked which fostered the normalisation of cruelty and the victimisation of those brave enough to speak up. For far too long warning signs were not seen, ignored or dismissed.’ (Patients first and foremost, 2013, p.5). Senior managers prioritized cost-cutting and cascaded orders down the hierarchy that failed to support patient care. Systems designed to draw the board’s attention to clinical issues failed to function and senior managers paid little or no attention to concerns expressed by staff, patients and relatives about the quality of patient care. ‘Targets and performance management … overwhelmed quality and compassion.’ (Patients first and foremost, 2013, p.21). Patients, their families, nurses, junior doctors, former employees, the local community and the NHS were all let down by irresponsible managers who were pursuing their own agenda.
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TASK
To ensure that the top management achieves success, you are expected to produce a 3000-word report. In this report you will be required to evidence the following with reference to the Seven-Step Transformation Process above:
Task 1: Evaluate and recommend a model of change that might be utilised in order to develop an environment that would allow the organisation to be competitive. (60%)
Task 2: Analyse what might be the major resistance from employees on the recommendations made above and, using appropriate change models and interventions, how might the CEO mitigate this employee resistance? (40%)
