The findings published by the Health Commission, the UK National Health Service (NHS) on the March 2009 Francis Report into Mid-Staffordshire NHS Foundation Trust Failures inpatient care, received a lot of publicity. While the report is important because it illuminates the failures, it is more significant to focus predominantly on what should have been done and what should be done in the near future. This calls for a review of the recommendations that have been tabled by this report as a chat on the way forward (Francis, 2010a).
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Review of the Recommendations
For purposes of clarity, this paper will review some of the recommendations so adduced in the report one by one, by first highlighting them and secondly by justifications based on the report, as well the common knowledge that accrues from documented best business practices.
Recommendation 1: The Trust must make its visible first priority the delivery of a high-class standard of care to all its patients by putting their needs first. It should not provide a service in areas where it cannot achieve such a standard.
Joss et al (2002) reckon that, as a principle, it is usually the client who is best situated/placed to echo expectations of a service or a product. This, therefore, affirms the old adage that any establishment must always be cognizant of the fact that everything begins with the client as the middle staff as well as the end consumer. In the case of NHS, the management seemed not very sure of the ongoings because they perhaps did not establish a tool of evaluation that centered on the customer’s opinion (Care Quality Commission, 2009).
The beauty of a client-centered approach in business, according to Joss et al (2002) is that it is a precursor for the management to foresee and create changes emanating from clients/clientele suggestions as well as demands, and therefore ordinarily shifting client’s information (Joss et al, 2002).
Recommendation 2: The Secretary of state of Health should consider whether he ought to request that Monitor-Under the provisions of the Health Act 2009-exercise its power of de-authorization over the Mid Staffordshire NHS Foundation Trust. In the event of his deciding that continuation of foundation trust is appropriate, the Secretary of State should keep that decision under review.
This recommendation would entail a number of advantages. First, in the event that the hospital is still authorized, then staff and management are likely to institute measures to ensure quality delivery of services since they will be acutely aware that they are under scrutiny. Because of this, the management is likely to re-examine its earlier approach with a view to retooling the strategies. They will therefore consider a SWOT analysis methodology in configuring their plan of action. SWOT has been defined by Joss et al (2002) as a useful technique used to comprehend an organization’s strengths and weaknesses, as well as for identifying opportunities obtainable and the threats that the organization faces. In the report, there seems to indication that the health facility reviewed its strategies with these facts in mind.
Recommendation 3: The Trust, together with the primary Care Trust, should promote the development of links with other NHS trusts and foundation trusts to enhance its ability to deliver up-to-date and high-class standards of service provision and professional leadership
This recommendation borders predominantly on consultancy and inter-aliases. Inter-disciplinary and consortia networks are important in management and service delivery. Joss et al (2002) observe that such measures provide alternative views that are often times influential in improving services delivery when incorporated. It involves the acquisition of Industry best practices (Francis, 2010b).
Recommendation 4: The trust, in conjunction with the Royal Colleges, the Deanery and the nursing school at Staffordshire University, should review its training programs for all staff to ensure that high-quality professional training and development are provided at all levels and that high-quality service is recognized.
Going by the finding that the clients were largely dissatisfied, the review of training and research should mainly focus on impact evaluation. Joss et al (2002) profoundly assert that impact evaluation is the methodological identification of the impacts and results caused by a program, policy or project including its strategy. These effects, accordingly, could be intended or not; however, the central thrust of impact evaluation is that it aids in an improved understanding of the degree to which programs reach the target group as well as illuminating their effects. Evidently, this seems not to have been taken at the training level, or if it was, then it was not implemented (Francis, 2010b).
Recommendation 5: The Board should institute a program of improving the arrangements for audits in all clinical departments and make participation in audit processes in accordance with contemporary standards of practice a requirement for all the relevant staff. The board should review audit processes and outcomes on a regular basis
Administration of drugs seemed to have been a bottleneck in the report; this was compounded by a lack of follow-up strategies employed by the health facility nurses and the hospital administration at large. One sure way of adopting this recommendation would be to take in the Rapid Appraisal Method, which, according to World Bank (2004), is a faster, reasonably cheaper way of collecting and collating views from the target group as well as other beneficiaries including the stakeholders in response to management’s need for valuable data. This way the management of the hospital would be able to adjust and retool their approach to treatment administration follow-ups by patients as well as nurses, and those that oversee this (World Bank, 2004).
Recommendation 6: The Board should review the Trust’s arrangements for the management of complaints and incident reporting in the light of the findings of this report and ensure that it:
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The report seems to contend that there is general complacency on the part of the staff. This could be because of a deep-seated culture where everybody covers each other’s back. Therefore, whistle-blowers are seen as betrayers. To correct this, the management should adopt policies, which take into consideration methods that assure confidentiality and deal with blackmail possibilities so that those that would want to volunteer information can do so willingly without fear of intimidation.
Recommendation 7: Trust policies, procedures, and practices regarding professional oversight and discipline should be reviewed in the light of the principles described in this Report.
Disciplinary actions are very important in any organization. It would be important for each of the Trust employees to be compelled to re-read and understand his/her job description. This would keep them on their toes and weed out those that are not performers.
Recommendation 8: The trust and the Primary Care Trust should consider steps to enhance the rebuilding of public confidence in the trust
From the publicity of their failure, public confidence seems to have been lost on the Trust. A good starting point would be to carry out a survey that focuses on the level of public confidence in it. With this, the trust would then institute measures that would win their trust.
Recommendation 9: All NHS trusts and foundation trusts responsible for the provision of hospital services should review their standards, governance, and performance in the light of this report.
A benchmark for delivery will be important in ensuring and defining the course of the hospital operations.
Those responsible for the Hospital failures
These should include almost everybody; the department of health, the patients themselves, the staff, the Board of Directors and Management (Francis, 2010a).
Way by which the management could have better organized their many performance measurements
The management ought to have better organized their many performance measurements in a number of ways: These include.
Use of Performance Indicators
Simply defined, performance indicators refer to dimensions that appraise inputs, outputs, processes, as well as the results for projects or strategies. These indicators usually enable managers to trail progress, reveal results, and take remedial exploits to improve service delivery. For instance, the contribution of “key stakeholders in defining indicators is important because they are then more likely to appreciate and use indicators for management decision-making” (World Bank, 2004).
The reasons for using them vary, but mainly they are meant to help in the location of performance targets and evaluation of their attainability. In addition, they are important for pointing out problems through an early caveat system to allow corrective action to be undertaken, and more so indicating whether an in-depth assessment or analysis could be required (Greasley, 2009).
The Logical Framework Approach
LogFrame has been defined as that which helps to clarify the goals/objectives of a project, policy and program. It helps in the identification of inputs, processes, outputs outcomes, and impacts. Ideally, it leads to the “identification of performance indicators at each stage in this chain, as well as risks, which might impede the attainment of the objectives” (World Bank, 2004). Moreover, it is a mode of engaging partners in illustrating objectives and crafting activities. During implementation, the Log frame serves as a useful tool to review progress and take corrective action (World Bank, 2004).
Rapid Appraisal Methods
These are seen as a “quick, low-cost way to gather the views and feedback of beneficiaries and other stakeholders, in order to respond to decision-makers” needs for information” (World Bank, 2004). It has several strong points including the provision of quicker data for decision making which is effective and efficient.
Key Stakeholder Groups
These include the government (particularly, the Department of Health), the Trustees of the Foundation, the patients/clientele group, the organization’s staff/employees, the Health Facility Board of Directors, the donors and the United Kingdom Health Commission (Francis, 2010a).
Lessons for the management and Government
From the above recommendations, the management and government can derive valuable lessons. First, there is a need for continuous assessment of health facilities to ensure that they are working all the time and are efficient. Secondly, they need to review patient satisfaction, especially by carrying out impact assessments from time to time. Thirdly, the management and government should review policy interventions in favor of standardized policies in service delivery. Fourth, there is a need for stringent adherence to strict Monitoring and evaluation methodologies. Lastly, there is a need for stringent inspections and evaluation of health facilities before the issuance or renewal of operating licenses.
Care Quality Commission. 2009. Care Quality Commission publishes progress reports on Mid Staffordshire NHS Foundation Trust. Web.
Francis, R., 2010a. The House of Commons Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust, Volume.1. HMSO: Her Majesty’s Stationary Office. Web.
Francis, R., 2010b. Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust Report, Volume.2. HMSO: Her Majesty’s Stationary Office.
Greasley, A., 2009. Operations Management. Second edition. Chichester: John Wiley & Sons.
Joss, S. et al. 2002. Clients First: A rapid Market Appraisal Tool Kit: Experience and Learning in International Corporation. Helvetas Publications No. 3. Web.
World Bank. 2004. Monitoring and Evaluation: Some Tools and Approaches. Washington D.C: World Bank. Web.