The first time I heard this quoted was from the charismatic Aiden Halligan... a conference some place...  it would have been at the end of a train ride, a motorway journey or a quick flight in-and-out.  It's a long time ago and I think Florence Nightingale was in the audience!

I remember he spoke without PowerPoint and said; "If you always do what you've always done, then you'll always get what you've always got."  Really... the blinding obvious.  It's a thought that now appears regularly in conferences and articles.  I guess it's a phrase that stands the test of time and captures the imagination of people in the same way it did me.  It's a hand-me-down phrase.

However; it made a lot of sense to me.  Wearied by the never ending changes to the NHS that never change anything; changes that just add layer upon layer of non-sense to make the layer-ers feel good and ignore what it must be like to be 'layered-on', Aiden made me take notice.

The quote intrigued me.  He omitted the derivation and I don't blame him.  It's taken me a lot of digging to find that it comes from the founder of the Ford Motor Company; Henry Ford.

Great quote.  Grabs your attention.  Makes you think.  It is a compass and a reference point.  Indefatigable logic.  But it is not enough.  It is unfinished business; it needs a second sentence.  A few more words to finish it off. 

'If you always do what you've always done, then you'll always get what you've always got'... then, we have to add; 'So if you want what you've never had, you have to do what you've never done'.

'Do what you've never done'... ouch!  That is tricky.

What we have never done translates into what we have never had.  If you ain't done it, we ain't had it.  We have never had what the chip-shop has had.  We have never had what the airlines have had.  By and large we have chips that are safe to eat and travel that gets you there and brings you home in one piece.  Healthcare seems to me, to have been a dark conspiracy to obfuscate and hide failings, foibles and foul-ups.  We have never had truly, reliable, honest-to-goodness safe health-care.

We have had the GMC, the NMC and countless professional organisations dancing around their handbags.  But none of them have made healthcare safe.  We have had public inquiry after public inquiry but healthcare is no safer.

Since 1999 the CQC, in its various guises, have patrolled the landscape of healthcare and last week they tell us a quarter of hospitals aren't safe.  Fat lot of good they have been.  More recently we have had Francis, Keogh and Berwick.  Are we any safer?  No, of course not.

'If you always do what you've always done, then you'll always get what you've always got, so if you want what you've never had you have to do what you've never done...'

What have we never done?  We have never challenged the worth of Nurse and Medical Directors on the boards of NHS Trusts.  I think it is time.

Since the Thatcher reforms of 1989, Nurse and Medical Directors have conjured the impression their presence on a Board has made healthcare safer.  Have they?  Or are they just the broken donkeys that plod through the landscape of healthcare with no energy, purpose or power?  Did these two posts make Mid-Staffs safe?  Have this dynamic-duo riled against the emasculation of the front-line of care in pursuit of a Board's ambition to balance the books? No.

Can anyone point to a Nurse or Medical Director saying 'enough is enough' and resigning?  How confused is their duty to patients with their loyalty to a failing organisation? 

Trusts are obliged to have the Apollo and Artemis, Ahriman and Ahura,  Castor and Pollux, the twins; nurse and doctor on the board.  History shows how little they have contributed.  These are vanity appointments, appeasing the professions and delivering an embarrassing legacy.

Marks and Sparks sell suits and sausages but don't have a tailor and butcher on the Board. There is no more justification for a nurse and doctor than there is an occupational therapist or radiologist or pathologist or brain surgeon or car-park attendant.

It's time for a Director of Patient Experience.