The Berwick Factor

I was really struck by the wonderful response to the Berwick report by Jo Bibby and her personal reflections (1) and how much I agreed with her.  

Like many I have my own story of meeting Don Berwick.  At conferences Don is usually deep in conversation with a group of people intently hanging on his every word, stopping every now and then to greet someone with a warm smile and words of encouragement.  I met him at the NPSA when the then new Chief Executive, Martin Fletcher, had just started, around seven years ago.  We talked about lessons from the IHI campaigns and their application to the initiatives we were wanting to take forward in the UK.  But the exchange that sums Don Berwick up for me, is when asked by the CE, ‘what advice would you have for me as a new CE? what would be the one thing you would do?’.  Expecting something like, ‘create will’, ‘support execution’ or ‘make sure you measure everything and teach people about improvement science’… he simply said ‘instil joy and pride into everything you and the wonderful people who work with you do and everything else will follow’.  This philosophy remains with him today and is thread throughout the outstanding report from the National Advisory Group on the Safety of Patients published this August (2).

I have been asked since the publication of the report why I think it is so good, ‘surely you have been saying the same thing for over 10 years’, ‘isn’t this what the NPSA and the Seven Steps to Patient Safety (3) already says..’? So… yes we have but sometimes it needs to be said differently, by someone different, in such a way and at such a time that finally people start to listen.  Don has a way of saying the same things as others differently.  It is authentic.  He has a way of talking to you and your heart.  The letters that accompany the report are genuinely moving.  

I have been saying for a very long time that the NHS needs to embrace the just culture, one that is fair, open, caring and supportive, not blaming, or fearful (4).  I cannot describe it any better than the closing paragraph of the letter to ‘Senior Government Officials’.. ‘I urge you to focus on the culture that you want to nurture: buoyant, curious, sharing, open minded, and ambitious to do even better for patients, carers, communities, and staff pride and joy.  If you read our recommendations carefully, and act on them, I believe that you will have set your compass right.’

Thank you, Don and the Advisory Group members, many of whom I have had the privilege to meet, I have set my compass and will continue to do my best to place the quality and safety of patient care above all other aims so that the NHS can continually and forever reduce patient harm.

(1) Jo Bibby @ The Health Foundation

(2) Berwick Report @

(3) NPSA, Seven Steps

(4) Woodward, A just culture