1979; a year of strikes, the death of Sid Vicious and Trevor Francis was the first ?1m footballer. The Tories introduced the 'Right to Buy'. Also, Phil Crosby wrote a book (I still have a copy) 'Quality is Free'.

His idea was that with a philosophy of 'zero-defects', you can increase profits both by eliminating the cost of failure and increasing revenues through increased customer satisfaction.

He spoke of Right First Time; 'a quality management concept that 'defect prevention' is more advantageous and cost effective than 'defect detection' and the associated rework'.

You don't need me to do the obvious read-across for health services.

But... it is easy to get hold of the wrong end of the stick. Zero-defects is not about being perfect. Zero-defects is about changing your mind-set. Think of three things:

*   Be honest about the high cost of quality issues (In the case of the NHS, financial and human).

*   Relentlessly seek out places where flaws are hiding, analyse data and learn from mishaps. (The NHS is a complex whole system with hundreds of pathway interfaces ready to trip up the unwary).

*   Work openly to address the flaws in your systems and processes.

The biggest obstacle for the NHS? The CQC.  We are content to champion people who find failure rather than make heroes of people who share problems and create success.  That's why I created the Academy of Fabulous NHS Stuff.  I don't believe we have to reinvent the wheel; just the way we work together.

'Zero-defects' is not a motivation programme, a target or even a benchmark. It is a mind-set, an attitude and a commitment. The key... be proactive. Accept things are not perfect but describe perfect and work backwards from there... putting things in place to achieve perfect.  Ask; 'what do we have to do to achieve perfect'?

You won't find what needs to be fixed if you go inspecting for it and bring the roof in when you find it; people will just become furtive, cover up their mistakes and be defensive. You have to share the ambition and ask; what does perfect look like and what do we need to change to achieve 'zero'.

I'm hearing there is an increasing impatience with the fumbling CQC. The latest (reported in the HSJ); their Board 'discovered' it takes longer to write one of their narrative reports than it does War and Peace.

Where have they been!  We know by the time the reports are published there is a good chance everything has changed and whatever relevance they might have had has evaporated.

The CQC has a growing budget and a diminishing influence.  People are just fed up with them.  They look gawky, impetuous and spiteful.  The Board, bewildered.  Everyone knows Trusts get hammered for not having enough nurses. It's become a non-issue and a routine criticism. Not having enough nurses can translate into 'less than optimal care'.

NICE guidance (Page 12) with its potty red-flag nonsense is no help.

Sub-optimal care translates into 'unsafe'. Unsafe becomes lack of 'good management', lack of management becomes 'poor leadership' and another chief executive bites the dust (Average length of tenure 2.8yrs). The CQC commentary on the NHS is like a stuck 78rpm record.

I'm told politicians would dump it if there was an alternative narrative that would avoid them being accused of not caring about quality.  They know the CQC is a poor quality system that has no impact on the quality of quality.
 

We know 16 years of inspection has delivered diddly-squat. In fact a 'diddly-squat' that costs ?100m pa at a time when the NHS doesn't have ?100m to waste on outdated management techniques.

It's impossible to compare the CQC narrative reports, there are no benchmarks that I can fathom, no way to compare results and inspections (insiders tell me), riddled with subjective opinions that 'inspectors' squabble over. I can calculate no return on investment for the tax-payer whatever. The CQC are peddlers of the bleedin' obvious.

The Danes have come to their senses and dumped inspection. Even the Patron Saint of safe hospitals, Don Berwick, has denounced inspection.

This is a Berwick presentation.  If you can find the time, make a cuppa-builder's and have look.  Well worth the effort.

Alternative narrative? Obvious:

"Sixteen years ago inspection fulfilled a roll, since then the NHS and our ability to assess what is safe, good and compassionate has moved on. We no longer have to rely on outdated methods. We can now use real time data, dashboards, audit, comparisons and listening to staff and patients to know what is happening. We can forecast, plan more accurately, measure what matters and make better use of the NHS resource to support the front-line of care.

It is time to move on and use all our efforts to invest, inspire, train and focus on being the world's first Zero-Defect-Health-Service, providing care right-first time."

We can do it ... if we want to.

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Sir Robert Francis, 

in conversation with Roy Lilley

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Academy of Fabulous Stuff;

Problems looking for solutions - solutions looking for problems.

New 'shares' every day.

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