Monthly Archives: September 2013

Talk Business Magazine: Bad Gamble

Mary Clarke, CEO of Cognisco, an employee risk assessment company, says many companies are in the dark about how their employees behave on the job.

Earlier this month the Parliamentary Commission report into Banking Standards, Changing Banking for Good made several recommendations about how banks could clean up their acts following recent scandals and failures.

One of the most notable recommendations was that senior bankers guilty of “reckless misconduct” should be jailed. Making bankers responsible and liable for their actions might bring about some changes, however will these recommendations really tackle the root cause – human error?


In recent months, we have also read about similar failings due to human error in the NHS, and I believe there are many other organisations that simply don’t understand how their employees actually behave in their jobs and the risks this lack of insight poses.

Employee misunderstanding and inappropriate attitudes towards risk may result in significant fines and loss of shareholder value. Analyst IDC says that 23% of employees misunderstand at least one aspect of their jobs, and that the cost of employee mistakes to UK businesses is estimated at £19bn annually.

Apply this globally and the amount of money wasted because businesses have been complacent about employee competence and risk, is astronomical. There is also the reputational risk for the board and subsequent impact this has can have on share price and the ability to trade and borrow, which can have a devastating effect. Companies need to find ways of identifying, and then managing, individuals whose behaviour could be deemed reckless, risky and unacceptable.


The first step is for companies to have better insight into the drivers of employee behaviour and ensure their employees are competent and confident when carrying out their duties. To do this, they need to have procedures in place to measure competency and behaviour, which are embedded into every part of the business.

However, while many companies adopt a robust approach to recruitment and put new recruits through their paces using psychometric and competency assessments, it is often the last time that employees are assessed. Many individuals will move through the ranks within a company, and their employees won’t really know if they are competent in their roles.

One way of mitigating these risks is for companies to introduce competency frameworks. The framework will outline the core competencies, the desired level of employee knowledge, motivation, behaviour and experience needed for each role. Then employees need to be regularly assessed against these frameworks.


One way of doing this is by introducing situational judgement competency assessments that can provide accurate, factual and objective results. The assessments that tend to produce the most results are those with well designed questions, which are validated by occupational psychologists and measure a combination of competency, knowledge and confidence in the application of that knowledge and other behaviours.

The recent scandals in banking and in the NHS have highlighted the need for organisations to gain a better understanding of their people and how they behave at work. It seems clear that processes and systems need to be put in place so that organisations can assess their people – and really understand their star performers as well as those that might be risky for business.


The NHS Needs to Manage and Mitigate People Risk’s to Improve ‘Patient Safety’

Up to 13,000 people may have died ‘needlessly’ in NHS hospitals since 2005, according to the government commissioned report Professor Sir Bruce Keogh, the NHS’s medical director, published last month. Professor Keogh was asked to look into hospitals with high mortality rates following the series of failings reported at Mid Staffordshire NHS Trust in February this year.

Keogh’s report criticised care standards and management failures in the NHS and raised concerns about a problem with the NHS’s culture, where whistle-blowers are afraid to speak out and regulators often fail to do their job.


The report also highlighted that the fallings at Mid Staffordshire NHS Trust were far from a one off. One of the 14 trusts investigated, Basildon and Thurrock University Hospitals NHS Foundation Trust, had 1,600 more deaths than would have been expected in seven years, according to The Sunday Telegraph. At Tameside – which is around half the size of Basildon – there were more than 830 excess deaths 11 NHS Trusts have now been placed in special measures.

The Keogh report followed an announcement by the Secretary of State for Health Jeremy Hunt the previous month that around 3,000 patients needlessly died last year as a result of poor care. Hunt claimed 500,000 people were harmed unnecessarily, while the NHS also recorded 325 “never events” – incidents so unacceptable that they should never happened. There is another consequences of these ‘never events’ too – the costs of these catastrophic ‘mistakes’ are reported to cost the taxpayer £3.9 million, the equivalent of £35,000 for each incident. However, Sir Bruce Keogh also says that it is clinically meaningless and academically reckless to use statistical measures to quantify actual numbers of avoidable deaths. yet the findings of this report and these other shocking statistics make a clear case for urgent change in the NHS and for major steps to be taken to address these serious incidents that are costing patients their lives and the NHS millions of pounds in compensation.


So what can be done?

In his report Sir Bruce Keogh points out that understanding the causes of high morality is not usually about finding a rogue surgeon or problems in a single speciality. He says it is more likely to be found in the combination of problems that are to a differing extent experienced by all hospitals in the NHS. The issues are often complex and require a “whole system” approach to deal with them.

For a number of hospitals, issues with capacity have led to a less than the minimum staffing levels and an associated cancellation of mandatory training. However, with an increasingly complex caseload and the need for £20bn of efficiency savings, something has to give.


Two of the key themes identified in the design of the Keogh review as being a core foundation of high quality care for patients are Safety and Workforce. With safety it is crucial that all employees are compliant with safety procedures and that training is implemented to improve safety performance.

However, NHS Trusts need to have a good understanding of their workforce competency and knowledge in order to achieve this. One way of doing this is to prioritise workforce planning and put in place comprehensive competency management systems that enable staff to be assessed regularly on the job, to ensure they are fully engaged, competent and confident in their roles.


It requires a team to focus on continuous improvement in relation to the mitigation of serious incidents and improved patient safety. Patient Safety is not just a key performance indicator. Nor can you just change processes for patients to become safe. It requires an entire hospital commitment to employee engagement, changing behaviours and a focus on competency management that identifies the ‘People Risks’ in the organisation including the skills and knowledge gaps, misplaced confidence of staff, their training needs and also any individuals with behaviour or actions that could be deemed inappropriate or risky.

NHS Trusts need to identify and address their risks – particularly their People Risk as one of the foundation steps in changing culture and improving their patient safety. They also need to uncover critical gaps at all levels and address them using highly targeted interventions designed to improve performance quickly.


Our KNOW solutions, that provides a focus on ‘People Risk’ has been used for the past three years by leading NHS Trust as they introduced a new approach to help eliminate the risks of serious case incidents and death in Obstetrics.

Last Year, the NHS paid $400m in obstetrics damages. So improving patient care and eliminating the risk of serious case incidents or deaths is a priority for every NHS Trust and our project is an example of how to achieve major progress in these areas.


We have shown how significant improvements can be obtained by measuring and correlating employees’ confidence with competence and then adapting existing interventions such as ‘Skills & Drills’ training to focus on the area of greatest need/risk, particularly where it relates to the behaviour of staff.

We devised an online tool that would evaluate midwives and doctors in simulated acute clinical situations such as postpartum haemorrhage (PPH). The assessment evaluated people’s confidence and communication skills, their decision-making and ability to spot risks, their approach to handling over to colleagues and their confidence is escalating issues. We now provide additional assessment including human factor and multiple births.


Since introducing these assessments the Trust involved has seen a reduction in the number of serious obstetrics incidents.

One of the key findings of the assessment is that employees often know what to do but lack the confidence to do so in an emergency situation. So, if organisations can measure an individual’s competence alongside their confidence level they will be able to spot how people are likely to act under pressure and provide coaching or mentoring to help them achieve greater confidence. Our programme requires organisations to take a regular health check of your employees before you put them through their training.


We also know that blanket mandatory training is not the answer. Instead organisations need to target their learning and development budget to where there is the most need and this is most effective when organisations have a clear understanding of their critical training needs.

The programme we introduced improved the performance of clinical teams when handling emergency situations, it has also benefitted patient care and, since it was initated, there has been a reduction in avoidable incidents.


The same approach could be introduced across NHS departments to improve the competence and confidence of multidisciplinary teams. Only with regular situational judgement assessments that map employee competence, confidence, engagement and behaviour will managers in the NHS discover and the decisions they are likely to make on the wards and critically when under pressure.

Once individuals and teams understand that this process is about giving them everything they need to know and understand to be confident in their role then the level of enthusiasm and dedication they feel toward their job is significantly improved. Engaged employees care about their work and about the performance of the NHS, and know that their efforts make a difference.


If an NHS Trust can change the way it looks at workforce competency, it will be able to continually inform improvement efforts such as: applying lessons learned from others, adopting innovative technologies, educating providers and consumers, enhancing incident reporting systems, and developing new levels of productivity.

At the same time organisations will be able to reduce the number of ‘never happen’ incidents taking place. Management has the obligation now to create the environment that fosters employee empowerment and ensures competent employees. They have the duty to accept this opportunity and demonstrate they are willing and capable of changing the NHS.


Cognisco specialises in identifying and addressing People Risk in organisations looks at how a radical shift is needed in terms of managing staff competency in the NHS to change the culture and reduce the risks of patient deaths.



Identifying and preventing risks would support Berwick’s goals for the NHS

Mary Clarke, CEO, Cognisco suggests that Professor Berwick’s goals for the NHS could be supported by the introduction of ‘people’ risk assessments that would identify and address risks before they compromise patient safety.

Earlier this month Professor Don Berwick, a renowned international expert in patient safety, delivered his assessment on the state of NHS, outlining four key recommendations to make the NHS the ‘global leader’ in patient safety.


The former adviser to President Obama, Berwick was asked by the Prime Minister to conduct the review following publication of the Francis Report and the scandals at Mid Staffordshire Hospitals.  Berwick’s four key findings are:

The quality of patient care, especially patient safety, should be paramount

Patients and carers must be empowered, engaged and heard

Staff should be supported to develop themselves and improve what they do

There should be complete transparency of data to improve care


Putting the quality of patient care first and ensuring patient safety may sound obvious, but it is a complex area that is difficult to measure. How do NHS managers accurately measure the quality of patient care without observing every interaction between patients and staff? More importantly can they identify poor quality care and address any problems before they compromise patient safety?

One practical way for NHS organisations to measure how their staff will actually perform, their attitude and behavior towards patients and their likely decision making is by introducing an assessment methodology that uses situational judgment questions to measure a combination of staff competence and confidence.


These ‘intelligent’ assessments don’t just measure people’s knowledge, they reveal how that knowledge will be applied in work situations and how confident they are that the way they are working is correct and appropriate. The results of such assessments produce the kind of accurate and transparent data needed by NHS Managers to improve patient care because they highlight critical skills and knowledge gaps and potential risk areas which if remain unaddressed could put  a patient’s life at risk. Such insight also enables Managers to provide targeted training interventions for staff to improve their specific skills and knowledge in areas where it is needed most.

For the past three years we have worked with a leading NHS trust and introduced these kinds of assessments to help eliminate the risks of serious case incidents and deaths in Obstetrics. Last year, the NHS paid £400m in obstetrics damages. Improving patient care and eliminating the risk of serious case incidents or deaths is a priority for every NHS Trust and our project has achieved major progress in these areas.


We have shown how significant improvements can be obtained by measuring and correlating employees’ confidence with competence and then adapting existing interactions such as ‘Skills & Drills’ training to focus on the area of greatest need/risk, particularly where it relates to the behaviour of staff. The programme has improved the performance of clinical teams when handling emergency situations, it has also benefitted patient care and, since it was initiated, there has been a reduction in serious incidents.

Berwick recommends that the NHS adopts a ‘culture of learning’ and that staff should be developed and improve what they do. Again through the use of assessments, NHS staff at all levels can improve their competence and confidence and importantly, take control of their personal development. Using regular assessments, competency standards can also be monitored so any potential risks to patients are identified and addressed with targeted interventions.


Berwick concedes that mistakes happen in every job and that only the ‘most reckless’ individuals will be punished. However, why wait until any mistakes happen if there is a practical way of preventing them? Berwick has laid out some very astute and sensible recommendations, however, he has failed to discuss prevention and the need to identify and address the root causes of problems. Only with a systematic approach to identifying risks will the NHS ensure patient safety is put first.