tag:theconversation.com,2011:/africa/topics/mid-staffordshire-6630/articlesMid Staffordshire – The Conversation2016-05-20T13:06:55Ztag:theconversation.com,2011:article/597132016-05-20T13:06:55Z2016-05-20T13:06:55ZEmotional intelligence may not make you a better nurse says report<figure><img src="https://images.theconversation.com/files/123356/original/image-20160520-27853-jtu6xc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Who cares wins – or do they?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=frMXfcb2cljZNrBLMFyUFQ&searchterm=student%20nurse&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=367351457">Patrice6000</a></span></figcaption></figure><p>The <a href="http://www.telegraph.co.uk/news/health/news/9851763/Mid-Staffordshire-Trust-inquiry-how-the-care-scandal-unfolded.html">death of hundreds of NHS patients</a> in two English hospitals in Mid Staffordshire in the 2000s led to the <a href="http://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN06690">Francis report</a> of 2013 which found that poor care was endemic in the region. The report made 290 recommendations covering everything from culture change to improved audit. This has driven much of the thinking around how standards in healthcare in the UK should improve. </p>
<p>The report put much emphasis on how student nurses should be recruited in future, recommending that nurse education programmes should recruit people who “demonstrate possession of the values, attitudes and behaviours appropriate for the profession”. As a result, English programmes now recruit student nurses based on their values <a href="https://www.hee.nhs.uk/our-work/attracting-recruiting/values-based-recruitment">using a toolkit</a> developed by Health Education England. </p>
<p>Yet there is little evidence underpinning the approach or its impact. Scotland has <a href="http://www.nes.scot.nhs.uk/education-and-training/by-discipline/nursing-and-midwifery/managers-and-educators/pre-registration-nursing-and-midwifery-programme/recruitment-and-retention-delivery-group.aspx">also spent</a> a lot of time and money in recent years looking at this issue, but no uniform approach has emerged yet north of the border. </p>
<p>In short, we are still not very sure about what “raw ingredients” nursing schools should be looking for in applicants to identify the ones that will develop into the best nurses. To help provide an answer, we <a href="http://www.nurseeducationtoday.com/article/S0260-6917(16)30040-5/abstract">have been</a> studying how the performance of student nurses is affected by their level of emotional intelligence – <a href="https://theconversation.com/explainer-what-is-emotional-intelligence-and-why-do-you-need-it-36437">in other words</a> their ability to understand and express their emotions and their awareness of the emotions of patients and colleagues. We also looked at the effect of past care experience, since this was another quality seen as important in the Francis recommendations. </p>
<p>We studied nearly 900 nursing students in two large nursing programmes in Scottish universities – Edinburgh Napier and the University of the West of Scotland. We measured their emotional intelligence at the beginning of their first year in nursing training in 2013 and took note of their experience working in care. Then at the beginning of the students’ second year and again in the final semester of their third year, we measured their performance and re-measured their emotional intelligence. We have just published the results from the first half of the study, namely how these variables affected the students’ performance during their first year. </p>
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<span class="caption">Testing times.</span>
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<h2>Trait or state?</h2>
<p>Students’ emotional-intelligence scores appeared not to make any difference to their performance on the course, yet changes in their scores over their first year made a difference as to whether they continued or not. Students exhibiting the largest drop in scores were more likely to leave the course than those exhibiting a modest drop. There was a small but statistically significant drop in emotional intelligence across the cohort over the year. </p>
<p>This might mean that measuring for emotional intelligence might be useful at identifying and supporting students whose scores have fallen most sharply. It is widely known that the empathy of <a href="http://www.ncbi.nlm.nih.gov/pubmed/22455699">student medics</a> and <a href="http://www.magonlinelibrary.com/doi/abs/10.12968/bjmh.2013.2.1.28">nurses</a> drops when they are exposed to patients. It seems that their emotional intelligence does too. </p>
<p>You might be surprised to read that emotional intelligence is something that can change. In fact, <a href="http://wp.unil.ch/ecp17/program-and-dates/scientific-program/personality-and-emotional-intelligence-trait-versus-state/">some scholars see it</a> as a fixed personality attribute while others see it as a set of behaviours and attitudes that can be learned – “trait versus state”, as it sometimes described. </p>
<p>The true nature of emotional intelligence matters greatly in our context. If it is a trait, it could be important for recruitment purposes. If it more like an ability, it could be developed and nurtured through nurse education. For this reason we measured for both possibilities – the <a href="http://www.eiconsortium.org/measures/teique.html">trait questionnaire</a> asks more about your personality while the <a href="http://www.eiconsortium.org/measures/sreis.html">state questionnaire</a> is more to do with how you perceive the world. When we measured all the students’ emotional-intelligence scores at the beginning of their second year to see if any changes had occurred, we found changes in both these measures. That somewhat challenges the idea of emotional intelligence as a fixed attribute. </p>
<p>As for previous caring experience, more than half of our group had some sort of relevant experience prior to becoming a student nurse. Surprisingly, perhaps, we found that those who had past experience tended to perform more poorly in the course in their first year.</p>
<h2>Where next</h2>
<p>It should be said that these findings can – and should – be criticised. For one thing, previous caring experience may not have the same negative effect in future years. It could be comparable to an experienced driver having to relearn how to drive in order to pass a formal driving test. Ultimately once they have shaken off all their bad habits, they may become a better driver. We are in the process of testing this. In a similar way, we are waiting to see whether the students’ future performance scores continue on the same trajectory as they become more experienced. This could affect the relationship with either of the variables we have been testing. </p>
<p>We also had to use a broad measure of performance which included both clinical and academic performance as the two were integrated in how they were taught and assessed. Colleagues have argued that this focuses on academic outcomes and doesn’t necessarily measure clinical performance, the key element under scrutiny by Francis. We would argue they are inseparable, since academic knowledge supports good clinical decision-making and caring by nurses. All the same, we would have measured purely clinical performance if it were possible. </p>
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<p>We are currently at the stage of completing our final data collection and will be able to more fully answer our questions following analysis of the three years of data. We also want to see how previous caring experience and emotional intelligence relate to the students’ future success, so we hope to continue following our cohort for another three years. </p>
<p>For the time being though, we would not recommend using either emotional intelligence or previous caring experience as criteria for recruiting student nurses.</p><img src="https://counter.theconversation.com/content/59713/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Austyn Snowden is a director of Snowden & Snowden, which does consultancy and research work in relation to chaplaincy in the NHS. It has received funding from NHS Education Scotland in the past. NHS Scotland also funded the nursing research project referred to in this article, but it was carried out entirely in an academic capacity. The views in the piece are entirely of the authors. </span></em></p><p class="fine-print"><em><span>Rosie Stenhouse received funding from NHS Education Scotland in relation to the research project explained in the article, but the views in the piece are entirely of the authors. </span></em></p>The raw ingredients that courses recruiting student nurses should look for are still a matter of debate.Austyn Snowden, Professor of Mental Health, Edinburgh Napier UniversityRosie Stenhouse, Lecturer in Mental Health Nursing, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/251142014-04-23T05:21:03Z2014-04-23T05:21:03ZFlorence Nightingale carried the lamp but modern nurses carry the can<figure><img src="https://images.theconversation.com/files/46815/original/b5dfxwkn-1398160076.jpg?ixlib=rb-1.1.0&rect=0%2C20%2C768%2C512&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Didn't go with the Flo.</span> <span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:Florence_Nightingale_three_quarter_length.jpg">Wikimedia Commons</a></span></figcaption></figure><p>What would Florence Nightingale make of present-day healthcare? Like anyone else, she would probably find much to admire – even much to be in awe of – but just as much of which to disapprove and despair.</p>
<p>We might reasonably assume she’d appreciate our technology and be greatly heartened by the extraordinary leaps made on this front that allow more time to be spent with patients. One of the cornerstones <a href="http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Florence-Nightingale-on-Advocacy.html">of her philosophy</a>, after all, was that healthcare is about “nursing the sick, not nursing the sickness”.</p>
<p>But she would be mistaken. It’s more accurate to say technology serves principally as a means of treating more patients, and is mainly used to get the conveyor belt they travel on to go faster. As the first female member of the Royal Statistical Society, Nightingale would surely discern as much if she were to set about familiarising herself with the metrics, targets and production-line methodologies that have come to dominate our way of working. It is also very likely that she would also detect the alarming reduction of the one characteristic she cherished above all others: compassion. </p>
<p>Nightingale might well pity her modern-day successors, the members of the profession she did so much to shape, who are habitually blamed for a lack of compassion when things go wrong.</p>
<h2>Selective memory</h2>
<p>“Compassion” was one of the healthcare buzzwords of 2013. The <a href="http://www.telegraph.co.uk/health/healthnews/9851763/Mid-Staffordshire-Trust-inquiry-how-the-care-scandal-unfolded.html">problems at Mid-Staffordshire</a>, where shocking failings led to unnecessary deaths and appalling levels of care, made it so. But by and large, interpretation of what compassion is and why it is relevant has been decidedly selective; while the importance of compassionate qualities in individual nurses has been much discussed, compassionate qualities in the healthcare system as a whole has gone strangely unremarked. </p>
<p>In truth, compassion should be central to the very broadest strategies. It should be fundamental not only to people but to process and place. In other words, it should be a focus not just for those who work within the NHS but for those who manage its services. Existing business-style models of management tend not to lend themselves to such seemingly lofty ideals. Optimisation and efficiency are frequently at odds with the basic notion of finding time to think, talk, identify with and understand. </p>
<h2>Restoring humanity</h2>
<p>But there is hope. The pernicious influence of threat and blame, assembly line mentalities and the pursuit of benchmarks, workflows and trajectories as an end in itself is at last earning a measure of wider recognition – the <a href="http://www.england.nhs.uk/tag/francis-report/">Francis Inquiry report</a>, which examined the causes of the failings at Mid-Staffordshire was one high-profile example. But recognition is also taking place more privately, as people, professionals and organisations grow increasingly disillusioned, amply indicated <a href="http://www.kingsfund.org.uk/blog/2013/02/letter-friend-non-executive-director-board-nhs-foundation-trust">in a recent blog</a> at the King’s Fund.</p>
<p>Far less appreciated, however, is how we sort out this problem. Education is one obvious answer. New public management thinking in recent decades – the language of business and bureaucracy – condemned the language of care to the margins. We’re now crying out for a renewed, and much greater, emphasis on how nurses can contribute in creative and practical ways to the design of compassionate interventions, processes and spaces. Something that reaches right back to Nightingale’s philosophy.</p>
<p>Physical surroundings also have a part to play. The workplace itself has to be conducive to compassion. Emotionally “warm” clinics are innately better than “cold” ones. Hospitals might usefully rediscover the concept of hospitality – not just for those they treat but for those who deliver the treatment. The <a href="http://www.theguardian.com/sustainable-business/blog/maggies-cancer-care-centres-healthcare-architecture">pioneering Maggie’s Centres</a> are a great example of this.</p>
<p>Whatever the specific answers might be, the overall goal should be to restore humanity to healthcare. The transformation doesn’t have to be inherently radical or, worse still, prohibitively expensive. It’s not so much a question of money: it’s a question of mindset.</p>
<h2>More than a minute spare</h2>
<p>Ultimately, what we need is a major move away from the current credo, which is that compassion is some sort of ointment that smiling practitioners can apply in the few seconds they have to spare. Healthcare is unworthy of the “<a href="http://books.google.co.uk/books?id=fyc4Qv-80-8C&pg=PA181&lpg=PA181&dq=alvin+toffler+blip+culture&source=bl&ots=IjFHbEtXqJ&sig=vot5S43RoStAFw398BeXPxoJI_c&hl=en&sa=X&ei=v3xGU4vvN4HAhAebk4GoCQ&ved=0CDkQ6AEwAQ#v=onepage&q=alvin%20toffler%20blip%20culture&f=false">blip culture</a>” that Alvin Toffler presaged more than a quarter of century ago, where encounters are limited to short “blips” often of five minutes or less across multiples sites.</p>
<p>Compassion has to be systematic. And the message (and a framework) needs to come from the top. Everyone needs to be on board, it’s not just something that can be relied on to ascribe culpability to a single group. </p>
<p>Nightingale was revered as a role-model, an inspiration, the embodiment of all that’s noble and human about nursing; by contrast, the nurses of today are treated as little more than scapegoats. That’s how things have really changed: she carried a lamp and they carry the can. And that can’t be right.</p><img src="https://counter.theconversation.com/content/25114/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Crawford does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What would Florence Nightingale make of present-day healthcare? Like anyone else, she would probably find much to admire – even much to be in awe of – but just as much of which to disapprove and despair…Paul Crawford, Professor of Health Humanities, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/228702014-02-06T14:31:45Z2014-02-06T14:31:45ZReports follow failure in the NHS but do they make a difference?<figure><img src="https://images.theconversation.com/files/40819/original/jtzqm7yp-1391637403.jpg?ixlib=rb-1.1.0&rect=30%2C56%2C993%2C668&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Swamped.</span> <span class="attribution"><span class="source">Klaus M</span></span></figcaption></figure><p>Do official inquiries and reports make any difference to how we run and regulate the NHS? It’s a year since Robert Francis published his findings following the high profile failings at Mid Staffordshire, where <a href="http://www.theguardian.com/society/2013/feb/06/mid-staffs-hospital-scandal-guide">shocking care and neglect</a> became all too apparent. </p>
<p>Whether all these reports, and Francis in particular, have an impact on how the NHS is run is important. Reporting on the failures and reforms of healthcare organisations is part of how we go about governing the NHS. And <a href="http://www.nuffieldtrust.org.uk/publications/francis-inquiry-one-year-on">a new report</a> published by Nuffield today – essentially a report on a report – considers what has changed in the NHS since the Francis Inquiry. </p>
<p>Since Francis we’ve had Bruce Keogh on <a href="http://www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/published-reports.aspx">mortality rates</a>, the <a href="https://theconversation.com/cosmetic-surgery-boom-not-a-sign-of-economic-health-22796">cosmetic surgery industry</a>, and <a href="https://theconversation.com/keogh-report-tackles-aande-supply-but-not-deeper-demand-20176">emergency care</a>; Don Berwick on <a href="https://www.gov.uk/government/publications/berwick-review-into-patient-safety">patient safety</a>, Camilla Cavendish on healthcare assistants and support workers, and Jane Cummings <a href="http://www.england.nhs.uk/nursingvision/">on compassion</a> – and there are more.</p>
<p>Mid Staffordshire happened because of terrible organisation failure and consequences surely had more than a shocking effect on the way hospitals are managed and audited in England. Francis was called a turning point after all. So why do we revisit it one year on? </p>
<p>It’s hard to predict the reactions to a report and not all carry the same weight. And even when they do, organisations such as NHS trusts are part of other regulatory schemes that make it difficult to effect change and it may also be near impossible for managers, however willing, to exert full control over the quality and cost of services they look after and the organisation’s culture. </p>
<p>Reports (and the counter publications that react to them) have an essential role in communicating thinking about an issue, raising awareness and pinpointing changing priorities, but if they don’t change the culture in an organisation then what is the point? The failings they identify are only likely to be repeated. Knowing what is wrong is great, but not if we don’t do anything about it.</p>
<h2>‘Unresolved dilemmas’ in Francis</h2>
<p>The Francis report <a href="http://www.midstaffspublicinquiry.com/report">made 290 recommendations</a>, including a call for a duty of openness among NHS staff. But there are two “unresolved dilemmas” in the way healthcare organisations like trusts are run and managed that I think stand out: </p>
<ol>
<li><p>How do you make savings without hampering quality of care – especially when quality means “objective quality”, so not just perceived satisfaction but the actual deterioration of outcomes for patients, such as death and recovery rates?</p></li>
<li><p>How do you identify and prevent procedures and professional behaviour that are close to being negligent and are part of the norm? Organisational failures often result from practices that are hard to identify, both by insiders (because they see it day-in-day-out) and outsiders (because they’re not there long enough to notice).</p></li>
</ol>
<h2>Incentives should target quality</h2>
<p>In the Nuffield report, senior NHS staff said Francis had given impetus to their efforts to put care quality first. But it also found that financial pressures and a complex regulatory system are making it difficult for hospitals to create a culture where patients come first. It comes <a href="http://www.bbc.co.uk/news/health-25981936">as one in three</a> hospitals trusts forecast they will be in the red by the end of the financial year. </p>
<p>The first financial dilemma suggests that excessive financial pressure comes at the cost of lower quality of care. That is, quality isn’t accounted for when financial incentives are set. When it comes to capitation payments, for example, healthcare providers are paid for each enrolled patient rather than the amount of care they give to those patients.</p>
<p>Of course, it is hard to predict how new financial incentives will affect an organisation. Initiatives to improve quality include ratings for trusts, <a href="https://theconversation.com/publishing-surgeons-performance-could-lead-to-gaming-15267">publishing performance</a> and highlighting best practices and so forth. But these are often not accounted for in the allocation of funding. So together with limited social incentives to quality, there are also limited financial incentives too. </p>
<p>Many organisations subject to financial pressures, put more weight on social incentives instead. Examples include motivating certain employees (nurses and midwifes, for example) to attain certain professional standards. Reducing the hierarchies within trusts and hospitals, for example, could allow information to flow more freely. And this leads us to the second dilemma, that of organisation culture.</p>
<h2>Culture is not independent</h2>
<p>Every organisation works within external restrictions, such as regulatory systems and commissioning services, as well as an internal set of norms and procedures that we call “culture”. And these aren’t independent of financial rewards. Organisational culture, as Francis rightly identified, is important because it is hugely important when it comes to safety. But a lack of financial rewards affect organisations as a whole and the effects often trickle down the ladder. If our aim is to improve the overall efficiency of the system then quality needs to be at the core of any incentives, not just cost alone. </p>
<p>But on the flipside, we know that excessive use of financial incentives can crowd out professional culture (or duty) to a certain extent and in doing so have <a href="http://www.theguardian.com/society/2003/sep/17/thinktanks.futureforpublicservices">a counterproductive effect</a>.</p>
<h2>So do reports work?</h2>
<p>It is fair to say that reports are just messengers. But messages are hardly ever found in one report alone but in the wider debate that they create on how best to address the key challenges of delivering healthcare. The Francis report and the report-on-the-report one year on consider the dilemmas inherent in the system, which we still have yet to answer: with financial pressures and cost-savings to be made, can we really change how we do things? There will no doubt be more reports on this to come. </p><img src="https://counter.theconversation.com/content/22870/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joan Costa-i-Font does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Do official inquiries and reports make any difference to how we run and regulate the NHS? It’s a year since Robert Francis published his findings following the high profile failings at Mid Staffordshire…Joan Costa-i-Font, Associate Professor of Political Economy, London School of Economics and Political ScienceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/168252013-08-07T13:48:06Z2013-08-07T13:48:06ZCreating new criminal offences won’t help NHS patients<figure><img src="https://images.theconversation.com/files/28858/original/4qrpmqvx-1375881432.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C1022%2C680&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our man from Boston: Don Berwick (left) has had some things to say about the NHS.</span> <span class="attribution"><span class="source">Wikimedia Commons/HHSgov</span></span></figcaption></figure><p>One of US President Barack Obama’s key health advisers has just published a review in the aftermath of <a href="http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-20965469">the Mid Staffordshire hospital scandal</a>. Don Berwick’s review is both thoughtful and reflective but one of his key recommendations - to create criminal sanctions against health staff – will not make the NHS safer for patients.</p>
<p>Many patients, particularly elderly ones, suffered unnecessary indignities and avoidable harm at Mid Staffordshire. </p>
<p>The <a href="http://www.theguardian.com/society/2013/feb/06/mid-staffs-hospital-francis-report">Francis report into the crisis</a> concluded that patients were routinely neglected by a health trust more preoccupied with cutting costs and meeting targets rather than its responsibility to provide safe care. Patients’ calls for help to use the bathroom were ignored and some were left lying in soiled sheeting or sitting on commodes for hours. Events and failings there will probably go down in history as the blackest and bleakest moment for the NHS. </p>
<p>When <a href="http://www.midstaffspublicinquiry.com/report">the report was published</a> in February, the government committed to appointing a advisory group of patients to consider the various accounts of what happened and the recommendations made by Robert Francis and others. The idea was that they would distill for the government and the NHS what lessons should be learned and what changes needed to be made.</p>
<p>Don Berwick, who worked on the long fought for <a href="http://bit.ly/12bq4rR">Obamacare provisions in the US</a>, is director and co-founder of the Institute for Healthcare Improvement in Boston. He <a href="http://www.theguardian.com/society/2013/aug/05/nhs-safety-report-berwick-review">was called in by the government</a> to reflect on the Francis report and on patient safety.</p>
<p>Berwick’s review makes ten recommendations including that sufficient staff are available to meet the NHS’s needs now and in the future - staff should be well-supported and able to ensure safe care at all times; quality and safety sciences and practices should be a part of the initial preparation and lifelong education of all health care professionals, including managers and executives; and leaders should create and support learning and subsequently change, at scale, within the NHS.</p>
<p>But most controversial is his final recommendation:</p>
<blockquote>
<p>We support responsive regulation of organisations, with a hierarchy of responses. Recourse to criminal sanctions should be extremely rare, and should function primarily as a deterrent to wilful or reckless neglect or mistreatment.</p>
</blockquote>
<p>Berwick proposes the government creates a new general offence of “wilful or reckless neglect”, applicable both to organisations and individuals. Organisational sanctions might involve removing leaders and disqualifying them from future leadership roles, public reprimand of the organisation and, in extreme cases, financial sanctions - but only where that will not compromise patient care.</p>
<p>This recommendation is perhaps a bridge too far. I am not sure what can be gained by exposing health organisations and individuals to criminal sanctions in this way. There are already effective civil sanctions that can be imposed in civil law. The tort of negligence is one example, under which compensatory damages can be sought from employers, and for individuals deemed to have broken their legal duty of care, there are contract and professional sanctions. </p>
<p>There is also the concept of gross negligence. The Health and Safety at Work Act etc 1974 has sanctions within it, though it isn’t applied as much as it could be, as does the criminal law - such as the Corporate Manslaughter and Corporate Homicide Act 2007 for example. If an assault, for example, is proven this can also lead to criminal proceedings. </p>
<p>In terms of the Mid Staffordshire scandal, there have already been cases: last month, two nurses who failed to spot a patient who died at Stafford Hospital was diabetic <a href="http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-23508894">were found guilty of misconduct</a>, while two others <a href="http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-23450764">were struck off the nursing register</a> for falsifying A&E discharge times.</p>
<p>The sanctions suggested by the Berwick report look like a criminal/civil hybrid provision that we don’t need.</p>
<p>Rather than creating more criminal law, the focus for change should be on helping doctors, nurses and other health carers develop a new sense of professionalism, free them from <a href="https://theconversation.com/if-anything-the-nhs-should-be-carpeted-with-more-competition-15787">a culture of targets</a> and let them focus on putting the patient’s interests first.</p>
<p>Developing an ingrained patient safety culture in the NHS will take time, and it will be an incremental process.</p>
<p>Waving the big stick of criminal law around - the law that applies to murderers and thieves - will not help focus the minds of health carers who are essentially a highly committed, skilled and caring group.</p>
<p>Linking quality of services to litigation over other avenues, as Berwick also lays out in his review, won’t prove the best way forward. Creating new criminal sanctions in an already increasingly legalistic environment will not make the NHS any safer.</p><img src="https://counter.theconversation.com/content/16825/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Tingle does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One of US President Barack Obama’s key health advisers has just published a review in the aftermath of the Mid Staffordshire hospital scandal. Don Berwick’s review is both thoughtful and reflective but…John Tingle, Reader in Health Law, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.