Berwick Report Emphasizes Learning, Empathy; Not Punishment

What happened at Mid Staffordshire Hospital was almost the perfect storm. Combine an absence of leadership and an over-focus on cost-cutting, and to that add discouraged staff, and you have all the ingredients for disaster.
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With great anticipation both here and abroad, the Berwick Report was released last week -- a report promising direction to the British National Health Service (NHS) after a devastating healthcare crisis in patient safety standards at Mid Staffordshire Hospital resulted in hundreds to thousands of unnecessary injuries and deaths. Warning signs were not heeded: "Especially costly," states the report, "was the muffling of the voices of patients and carers who took the trouble to complain but whose complaints were too often ignored." Prime Minister David Cameron turned to world-renowned patient safety expert Donald Berwick to make recommendations with the goal to "help the NHS achieve 'zero harm'."

Many patients and families who'd suffered harm sought sanctions for the NHS staff during this crisis, while unions and campaigners demanded new national standards for minimum staffing for NHS hospitals.

Instead, the review calls for enhanced training and education at NHS to focus on patient safety and quality improvement. Berwick's advisory group -- which included career scholars of patient safety, clinicians, managers and, most importantly, patients and patient advocates -- recommended a broad culture change in the NHS. "The way out is through learning, curiosity, commitment, and empathy rather than anger, fear and blame." The report points to a complete systems failure rather than finding fault at the individual staff level (reserving criminal consequences for those guilty of willful neglect of a patient).

All hospitals must make patient safety and empathy the core of their institutional missions -- anything less is unacceptable and dangerous. One of the ways the NHS failed was turning its efforts toward cost reduction too swiftly, and when that shift in hospitals occurs, corners are cut and a subtle erosion of standards and empathy follows; behaviors that would have once horrified staff members become commonplace. Cost reduction is a critical agenda for all healthcare systems and true patient-centered care may, in fact, be one of the most powerful tools we could have for cost reduction, since not hearing patients and families leads to many forms of overuse and inaccurate care.

Berwick's non-punitive and encouraging approach on this devastating situation is in itself an act of empathy, what must be the cornerstone of any healthcare setting. His recommendations to "foster wholeheartedly the growth and development of all staff, especially with regard to their ability and opportunity to improve the processes in which they work" and "engage, empower and hear patients and carers throughout the entire system, and at all times" are crucial -- caregivers should also receive care via programs designed to emphasize empathy, bolster morale and their quality of care, help caregivers avoid burnout and, importantly, give agency to their feedback and complaints.

What happened at Mid Staffordshire Hospital was almost the perfect storm. Combine an absence of leadership and an over-focus on cost-cutting, and to that add discouraged staff, and you have all the ingredients for disaster. Quality of care is dependent upon a hospital culture that is committed to support, education, and evidence-based improvement. For example, the Empathy & Relational Science Program at Massachusetts General Hospital in Boston exists to conduct research at the neuroscience, inter-professional and systems levels. Such research informs training to optimize patient-clinician interactions and to improve communication at all levels of healthcare. Drawing on the neuroscience of empathy, clinicians and staff and leaders benefit from training in active listening and empathic communication. Clinicians learn to deliver compassionate care as well as to practice the art of self-care, which is necessary in stressful and highly emotional work settings. To prevent the institutional derailment and moral slippage seen at Mid Staffordshire Hospital, a scaffolding of resources and outlets for clinicians and staff must be in place, as well as leadership that embrace patients as the pinnacle priority. Anything less than a commitment to excellent patient care is unacceptable.

The bottom line is that the NHS scandal was preventable. But Berwick's report is the saving grace, and his reinforcing of the patient-focused mission hospitals must uphold, as well as the necessary initiatives and protocols that must exist for staff, is now being read around the world. And, with that, a hope that other hospitals in similar situations take his recommendations to heart.

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