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Mission, vision, and values statements in healthcare: what are they for?

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4331 (Published 25 June 2012) Cite this as: BMJ 2012;344:e4331
  1. Nadeem Moghal, consultant paediatric nephrologist, Newcastle, UK
  1. nadeem.moghal{at}ncl.ac.uk

Healthcare organisations, probably the world over but certainly in the UK, have aped corporate behaviour in other sectors in establishing statements of mission, vision, and values that purport to describe why they exist and set aspirational direction. Their statements can be found on websites in the “about us” section, in glossy annual reports, on posters staring at you as you wait in the emergency department, on headed paper, and maybe even on corporate mugs. Some if not all of these statements will have been the result of earnest and meaningful executive and non-executive soul searching on away days.

What is the primary purpose of a healthcare provider? Why does a healthcare provider exist? To coin a phrase, “To provide healthcare, stupid.” Who provides that healthcare? “The clinicians, stupid.” Do the clinicians need mission, vision, and values statements to remind them why they do what they do, why they come to work, and why they exist? Perhaps. After all, there seem to be enough examples of troubled services that would be served by a mission statement to remind staff why they are there.

A review of one region’s collection of mission, vision, and values statements, filtered through a word cloud application, which gives visual weight to words in proportion to their occurrence, reveals the most dominant words to be: “patients,” “quality,” “services,” “care,” “staff,” “health,” and “best.” If you were to while away time reading these statements either your eyes would glaze over as you lost the will to live, or they would roll up as you wondered if these imploring, aspiring statements really would inspire and motivate the workers, draw patients away from potential competitors, and give meaning to the organisation. What you would recall of these statements is, I suspect, very little.

Despite these contorted and often duplicated statements, every one of these organisations surely has only one primary reason to exist: to prevent illness, cure disease, and relieve suffering, delivered by reliable systems of care, and delivered by people who care. What is missing in this statement are marketing fodder words—“excellent,” “the best,” “cutting edge.” What is in this statement is the word “reliable”—that is, a system in which the patient sees the right person at the right time in the right place for the right care; an operational definition that can be used to measure system reliability, and it comes with a number.

More critically, a reliable system, by definition, delivers quality care. “Reliable” assumes an understanding of its meaning in healthcare so perhaps the statement could read: “To prevent illness, cure disease, and relieve suffering, delivered by quality systems of care, and delivered by people who care. A quality system can be delivered only by a reliable operating system.”

Is it necessary to be explicit about healthcare being delivered by caring people? Surely we all come to work to deliver care, and caring is what we do. Perhaps. But we know from a sea of data, including complaints, litigation, seemingly failed and failing trusts, investigative journalism, and patient feedback tools, that we cannot assume that caring is part of the DNA of all those who interact with and contribute to the care of patients.

If “To prevent illness, cure disease, and relieve suffering delivered by quality systems of care, and delivered by people who care” is what defines the why and the how for a healthcare provider, how can any individual provider possibly differentiate itself from its neighbouring trust or competing service? Does the mission, vision, and values statement draw a patient into an organisation for that cure or relief of suffering? Do the statements indicate how a general practitioner or clinical commissioning group is going to make a decision for the patient? Even if we get into a genuine competitive market, are the mission, vision, and values statements the basis of consumer choice? The consumer is surely more interested in, we are repeatedly reminded, how good the organisation is based on outcome data. We all want to be the best. But how good are we now? And are we improving?

If the staff delivering the work on the ground know why they do what they do, and the users of healthcare services continue to access the nearest and most convenient service rather than most aspirational, then for whom are these statements intended? Might they be for those who work in healthcare organisations not delivering the clinical work but managing the organisation at some distance from where the clinical work is done? Do they, the managers, executives, and board members, need to define for themselves a purpose for their existence? They go on away days to define organisational purpose and come back with some “groupthink” articulated in a mission statement—the modern manifestation of the early 20th century factory floor poster, imploring and reminding workers, the people who deliver the purpose of the organisation, to work harder to deliver that purpose. Delegating inspiring leadership to mission, vision, and values statements is not inspiring leadership. It isn’t any kind of leadership.

A straw poll of nurses, doctors, and healthcare assistants confirms that no one can begin to recall even a fraction of these statements, because they have no obvious meaning or value for them. I have not been brave enough to test an executive. One day the “about us” section of a trust’s website might be less about statements of mission, vision, and values, and more about the data that show the clinical and experience outcomes that reveal the reliability (and therefore the quality) of the systems of care that the healthcare provider exists to deliver, and improve.

Notes

Cite this as: BMJ 2012;344:e4331

Footnotes

  • Competing interests: the author has completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review: Not commissioned; not externally peer reviewed.

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