Solve Your Problems at Source

Early in my career, I remember sitting in my London office when I received a call from a client in the north of England. There had been a complaint from a female member of the client against one of my consultants. This was well before #MeToo but the complaint was similar. My consultant had been just a little too forward and upset her.

Although we were over 200 miles away with different plans for the afternoon my business partner and I did exactly what we thought was right. We were in a car and driving north within 30 minutes. It was a long drive, we had nowhere to stay, but the problem had to be addressed.

By the time we arrived on site, the problem had almost gone. The consultant had apologised, and it had been accepted. The client had forgiven the incident which was not as serious as it had first seemed.

We logged into a hotel and in the evening over dinner reminded the full team of their responsibilities and the standards of behaviour that were expected of them. The next morning, unshaven and in the same clothes, we went to our client, again apologised and explained what we had done the previous evening.

A potentially significant problem had been diffused and we returned to London.

It was about two weeks later when we received the letter that asked us to bid for new work and extend the existing work. We won that work as well.

Speaking to the client he said that we had been chosen not just for the quality of our project but the speed and focus of the way we had addressed the problem.

It was a salutary lesson. Everyone makes mistakes and to deny otherwise is stupid. What is important is how you address and resolve problems and issues.

I thought about this as I read the awful story that over 450 older patients at the Gosport War Memorial Hospital in England whose lives had been shortened by excessive prescriptions of Morphine and Diamorphine. An inquiry found doctors at the hospital gave patients dangerous amounts of these powerful painkillers. Despite a long report, there will be more information as a criminal investigation is now underway.

After the sadness of the early loss of so many lives what is as depressing was that there were warnings from nurses and many others over a 20-year period. The families of the deceased had been complaining and making noises and regulators, health commissioners and even the police had been looking but doing nothing.

We can never condone the doctors at the heart of this tragedy. We must though reflect how these supervisors of our safety have conducted themselves. The quality of a system or institution is measured by how it responds when things go wrong.

Not only must the perpetrators been brought to account but so must the system and those in the system who failed to respond. The whole structure of the NHS has been found at fault.