4 may 2013, on being defensive

At every board meeting of the healthcare trust I am a (non executive) director of, we drag in a patient to come and talk to us about the care and service they received. The idea is for someone to tell us something that has gone wrong in a way that would never quite percolate upwards from staff, who at every level, very naturally paint the worst in the best light. The totemic "vasegate" incident, which is at the centre of a convulsive questioning of how good care really is in the nhs, shows how hard it is at the top to know what's going on at the bottom. It also shows the true value, however hard it is, of seeking and examining criticism. I am quite sceptical about how self-critical people can really be, and have seen any number of situations where people of all types fall so easily into a defensive posture when challenged about something they have done or that happened on their watch. We are currently doing appraisals (at my other job), and I have gone out of my way to urge colleagues to get critical feedback to play in, as everyone (especially me) makes mistakes. There is an incredible amount to be learnt from those mistakes, but only if we are able to admit them and set ourselves to putting right whatever was the thought or process that led to them. The challenge of others is crucial to this, and such challenge is quite hard to create and to sustain, not least because whoever is giving it is likely to be seen as tiresome and probably unhelpful. They are not, but are a crucial, strengthening part of any system; what doesn't kill us makes us stronger. Mid staffs (where patients drank water from a vase in thirsty desperation) shows the corollary, that if we're not made stronger, it might just kill us.