US expert calls for NHS to reach “entirely new and better level” of safety

BMJ 2013; 346 doi: (Published 24 April 2013) Cite this as: BMJ 2013;346:f2654
  1. Krishna Chinthapalli
  1. 1BMJ

Donald Berwick will urge the NHS to “bring patient safety and quality to an entirely new and better level” in his forthcoming report to the government. Speaking at the International Forum on Quality & Safety in Healthcare in London on 19 April, he also outlined his personal solutions.

Berwick, former head of Medicare and Medicaid in the United States and co-founder of the Institute of Healthcare Improvement, had been asked by the prime minister to chair an advisory group to advise him on improving the safety of NHS patients.1

Berwick said that the report would be brief, to the point, and ready by July. Emphasising that his ideas did not necessarily reflect the advisory group’s views, he put forward his response to Robert Francis QC’s report into Mid Staffordshire NHS Foundation Trust.

He thought several improvements were needed:

  • Clearer structures for early detection of deviation from excellence, and more prompt remedies

  • New training for healthcare professionals to arm them with the skills to see, speak up, and help change care, and

  • An entirely new relation with patients and carers.

Berwick said that hospital standardised mortality ratios (HSMRs) were a “very powerful although admittedly controversial metric” that should be accessible to everyone, especially patients.

“[An] HSMR can be and is even now used to ring an alarm when death rates persist far from the expected range. [At Mid-Staffordshire] it was not just ringing, it was clanging.”

However, Berwick did not think that individuals should be blamed and should not be considered as enemies of quality and safety. “The answer to the question about the enemy will . . . be completely unsatisfying if you’re looking for an enemy. I think that’s the wrong quest. I cannot urge an eye for an eye. This is not, in my opinion and only mine, a plausible cure or a certain remedy,” he said.

He also warned that lapses at Mid Staffordshire should not be treated as isolated. “You may escape the Guardian headline and the public inquiry for now,” he told conference delegates. “You may escape the glare because it is likely that some place right now is worse than yours.

“But the single patient now in your operating room about to get an infection that is avoidable, or the grandmother who is right now getting a bedsore that will keep her forever from seeing her grandchildren graduate, or the young boy whose sepsis is about to be missed, or the dignified women who is about to wet her bed because no one came when she called—every single patient, in that moment, [is] on your watch, in your place in his or her own Mid Staffordshire.”


Cite this as: BMJ 2013;346:f2654


  • The International Forum on Quality & Safety in Healthcare is an annual conference that is co-sponsored by the BMJ Group.