‘Learning from Excellence’
Dr Adrian Plunkett
LSA President, Dr Ed Djabatey welcomed everyone to the meeting and presented the John Utting Award to Dr Richard Berwick. He then introduced Dr Adrian Plunkett, the evening’s speaker.
Dr Plunkett started his lecture by explaining the lightbulb moments that led to him forming ‘Learning from Excellence’ (LfE) including his own experience of being a patient, the contributing factors that lead to doctors making mistakes and the importance of understanding the reasons that they’re made. He said that he was cared for by a nurse practitioner who, through displaying compassionate competence in her treatment of him, embodied excellence. He explained the difficulty of defining what exactly is ‘excellent’ as it is a subjective term, but he perceived her care as being excellent. He had written a letter, the first excellence report, to the hospital feeding back who had given excellent care and what it was they did that made it excellent. He wanted those people and the organisation itself to receive some formal positive feedback and reinforce the good work they were doing. He said years later that he found out that none of the people he had written to the organisation about, had received the positive feedback he had provided. He thought that we don’t treat this kind of recognition as useful intelligence and give it the same status as complaints, which receive a mandatory response.
He thought that he should do something about that so LfE was set up to capture much of the good work that goes on without any acknowledgement. He said that we don’t do this routinely as we are always trying to learn from what went wrong. Our traditional approach to safety is to look at errors and accidents, but it is a tiny part of the system. What we should be doing is looking at the whole spectrum and learning from the entire system. Safety is not what’s going wrong, but what’s going right. He described terms used with regard to safety and they tend to be negative but he also asked people for positive terms, which, though tend to be more woolly, can provide learning. He spoke about positive human factors, another term which tends to bring negative terms to mind. He spoke about these positive human factors including ‘kindness’ and mused on whether would more kindness in the system make it safer? So he thought that if you can capture, in an excellence report, that someone was kind, generous and compassionate and then report it back to them, the positive re-enforcement may make them more likely to repeat their actions. They are then more likely to recognise it in others so sending out a positive ripple effect. He talked about the ‘learning’ aspect in ‘Learning from Excellence’, the question being, can you learn from positive feedback? He gave an example of a report involving a drug error. The member of staff responsible for the drug error wrote an excellence report about the consultant who supported them through the incident and that he probably didn’t realise the impact that this support had had on their handling of the incident. Dr Plunkett said he was that consultant and he hadn’t realised, but when he received this report he changed his practice to always react and support in this manner when incidents occur. Consequently, he has learned from this excellence report and changed his practice.
The common misconception is that we learn best from failure, but Dr Plunkett showed some experiments done by a neuroscientist which showed that you develop stronger, longer lasting and more rapidly forming memories when you learn from success than when you learn from failure. LfE highlights positive interactions and events in an environment where the prevailing approach is learning from failure. He talked about more evidence from sports psychology where positive feedback improved performance and also that those who received positive feedback had enhanced memory. Staff in his hospital reported back that LfE improves motivation and he showed a study on antibiotic stewardship and unilateral positive feedback (no negative feedback given). Over a year, the processes improved and the ones that had the most feedback had the most improvement. He said the overall use of antibiotics was reduced with no increase in infection rate. IBM also did a worldwide study showing a relationship between engagement and receiving recognition for your work and it showed a 76% v 28% engagement rate in those who did and did not receive recognition. NHS performance is reliant on staff engagement so recognition is important in this. If failure is studied, then this is what will be learnt about. In contrast, if excellence is studied, that is what is learn abou. He then spoke about the LfE conference in Birmingham in February 2020.
Dr Plunkett then took some questions from the floor and Dr Frank Potter gave the vote of thanks.
Dr Gemma Roberts