OVERVIEW
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Introduction
Perhaps the last few years of the NHS should be dubbed the decade of the report. Starting in 2008 we have had Lord Darzi's call for quality for all.1 This was followed by Sir Bruce Keogh's report2 into the quality of care provided in the 14 trusts with outlying mortality data. Then not long after came the Berwick review3 into patient safety and the Francis enquiry4 into the failures of Mid Staffordshire Hospital. Then just this summer has come the Rose review into NHS leadership.5 Each report has provided wide reaching, forthright and comprehensive suggestions as to how to improve NHS services. However, the rapidity of five reports in less than eight years, combined with the fact that mean report length is 83 pages, concerned us that we were in danger of ‘report fatigue’; losing sight of the major findings through being overwhelmed by data. Therefore as trainees rotated to one of the trusts featured in the Keogh report we undertook a survey of 100 doctors to review their awareness and understanding of this report published less than two years previously.
Results
Of the 100 doctors surveyed 37 were consultants, 10 were staff grades and the remaining were varying grades of junior doctors. The doctors on average had been working for the trust for 6.3 years (range 0–30) which equated to two-thirds of them being employed by the Trust during the period of Sir Bruce Keogh's report. Despite this, when asked ‘There was a major report focusing on 14 trusts (including this one) approximately 1 year ago what was it called?’ only 47 responded correctly. A further one-quarter claimed it was the Francis report, 17 admitted to not knowing and 5 plumbed for the sham answer of the Leveson Inquiry. In light of this response it makes the results in Fig 1 less surprising. Almost 50% of those responding admitted to not attempting to read the report and only 16% managed over half.
Percentage of responders by the amount of the Keogh report they have read.
Not surprisingly, therefore, when asked to name a single recommendation from the report just under one-quarter could do so. Furthermore, these were often vague statements such as ‘more transparency’ or ‘encourage whistle-blowing’ which may reflect a more general response to the leading messages found in the more recent Francis report. Nonetheless, our results are not entirely negative. Notwithstanding the paucity of personal knowledge of the contents of the Keogh report, over 80% of the responders felt that it had positively improved the trust – a point further highlighted in the more recent Care Quality Commission inspection.6
Discussion
Whether our results are secondary to report fatigue as postulated above, or a symptom of clinical staff already overloaded with important information, they do highlight a staggering discordance. These groundbreaking reports came at a cost of millions of pounds and with thousands of hours of expert and hard work. Yet the job seems left unfinished. Our survey shows how the difficult job of transposing hundreds of pages into effective and easily understood learning lessons has clearly not been translated to the frontline workforce. We seem to have reached a point where an enormous amount of wisdom is in danger of being squandered if we continue with the cycle of repeated large-scale reports without addressing the fundamental problem of communicating their recommendations effectively and memorably. So perhaps rather than another decade of the reports, the second half of this decade should be dubbed the decade of their dissemination and implementation.
- © Royal College of Physicians 2015. All rights reserved.
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