• 07 August 2019
  • 45 min read

Care Home Quality Podcast - episode 6 with Medical Director Dr. Umesh Prabhu

  • Liam Palmer
    Registered Home Manager

Liam speaks with Medical Director, Dr Umesh Prabhu, about the tragedies he’s dealt with in patient safety and the importance of staff happiness, and how he’s transformed organisations along the way.

Topics covered in this podcast

0.00 Introduction to the Care Home Quality Podcast

0.58 Introducing Dr Umesh Prabhu

5.38 The turning point in Dr Umesh’s career

9.36 How Dr Umesh handles the pressure of patient safety

13.47 How he transformed an organisation

18.40 Taking charge of the organisation

23.06 Values and leadership

30.36 System Failures

34.52 Why staff happiness is important

40.11 Advice for other managers, junior doctors, nurses and the like

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Who is Liam Palmer?

Who is Dr Umesh Prabhu?

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0.00 Introduction to the Care Home Quality Podcast

Liam:

I like to open by thanking my sponsor, the provider of the popular job websites Nurses.co.uk, and also Socialcare.co.uk.

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0.58 Introducing Dr Umesh Prabhu

Hello everyone, this is Liam Palm here. Welcome to the Care Home Quality Podcast: Meet the Leaders and Innovators.

This is the 6th episode and as promised I'm pleased to introduce Dr. Umesh Prabhu.

I came across Dr. Umesh on LinkedIn actually, he's a lead voice about standards of leadership in health care and whilst his work is predominantly in the NHS, his lessons, his experience are invaluable and absolutely applicable to obviously the private sector where I work.

It's less about the environment of the organization that he did it for, it's more about the approach he took, it's more about the learnings, it's more about Leadership Lessons and he has such a depth of experience.

In my view, very much a VIP in healthcare, and for me, it was a real coup to capture his story for you, talking about how a certain approach to management and Leadership can get better health outcomes better patient outcomes.

I think it's a radical message that not many understand and I think Dr. Umesh has the credibility, he has a track record having delivered it in several NHS trusts.

So I hope you enjoy this really a remarkable professional, a remarkable leader in healthcare from which I'm sure we can all learn.

Hello everyone, this is Liam Palmer. Welcome to the Care Home Quality Podcast. I'm delighted to be introducing Dr. Umesh Prabhu who's going to be talking to us about patient safety and his journey and is lessons to become a leader in teaching how to run healthcare organizations, well, how to increase patient safety through culture and effective leadership.

So without any further ado just like to say hello to you, Dr. Prabhu.

Dr Umesh:

Hello. My name is Dr. Umesh Prahbu. I was a consultant paediatrician for 17 years, then I became Clinical Director then I became Medical - I've been medical director for last 15 years.

I was medical director of Bury NHS trust from 1998 to 2003.

I was board member of national patient safety agency from 2001 to 2003.

I was National advisor for poorly performing doctors for 15 years in the country.

And then I went to work in Wigan and Leigh where I was medical director from 2010 to 2016, where we reduce harm to patients by 90%.

Please note. I didn't do it it was done by working with our amazing staff. And they really worked hard and we reduce harm to patients by 90% because I live and breathe patient safety and quality.

Liam:

So just to explain to the listeners where I came across Umesh, Umesh is quite a controversial voice, voice of reason on Twitter, on LinkedIn.

He writes a lot about leadership, has got very very broad experience in the medical field, but my particular interest is how he connects the culture of an organization with quality and safety outcomes because that's an area as you guys would probably know interest me, and what I found fascinating with the mesh is that he's done a big piece of work with an NHS trust where he's implemented a culture with different values and he's got completely different results.

And this does make him a bit of a maverick in the NHS but actually a real inspirational figure because it's my experience that those values and those principles actually work regardless of the context.

So let's talk about that if we will Umesh, talk to me about where did you get these ideas from and talk to us about how you implemented it and what happened?

5.38 The turning point in Dr Umesh’s career

Dr Umesh:

Liam, nobody sets out to be leader, my passion is patient safety.

In 1992 with in being a consultant for four weeks, I made a serious mistake and six things went wrong and six week old baby developed severe brain damage. I made the final mistake.

There were two babies with the same name, same date of birth next to each other and I saw a very faint mark on the baby.

I didn't know whether it was a birthmark or a bruising due to child abuse.

Child was only 6 weeks old. I told my junior to get a special x-ray known as skeletal survey and he didn't know there was one more baby with the same name, same date of birth.

At the end of the ward round, he requested for the wrong baby and he gave it to the nurse who was not in my ward round, so she didn't realize she was taking the wrong, baby.

She brought the X-ray back give to the sister who was in my ward round.

She thought it must be for baby Smith A, so you can see how things went wrong. I was very busy in the clinic, I finished a clinic at seven o'clock.

I went to the ward, I looked at the X-ray. I didn't realize it was the wrong baby and I sent the baby home.

Stepfather was abusing the baby, he stamped on the baby skull and baby had severe brain damage, and be was admitted to neighboring Hospital in Rochdale within three days.

And the consultant rang me I was devastated.

This is what happens to doctors.

I became a paediatrician to make children better. Here is a baby who develop brain damage, which I could have prevented.

I called everybody sat around the table. I realize what six things had gone wrong.

I put six systems in place, I thought that was the end of it. Within four weeks, the thirty-six-week old baby died.

I didn't make any mistake, nurses and the junior doctors made mistakes before things went wrong.

Both these affected me significantly. I felt I was unfit to be a doctor, let alone consultant paediatrician.

I wanted to go back to India because any such incident affects me because I'm a doctor, doctors care for each and every patient.

But I met a lot of wonderful people. I went to Oxford to see my mentor whom I had worked as a senior registrar.

He was very fond of me and he said Umesh, don't do it. You owe it to these two babies.

That one sentence transformed me.

He said try to understand why doctors make mistakes. So since 1992 I've done nothing but why doctors make mistakes system failure, I've given 300 lectures and it has become a mission from me and my aim is to make NHS safest and the best.

Liam:

I mean, it's a lot to take in with your background as medical director, and I think the scale of responsibility, as listeners know I run a care home, you know with 60 or 80 people but we're talking, you know big hospitals you rather trust the scale of responsibility is you know beyond walking grasp I think.

But so what you're saying is the prevent in theory preventable deaths of children had motivated you to understand the interplay between processes task behaviours of professionals and then you've looked at that and said, you know, we need to do better.

We need to, I mean when we talked before we met you were talking about how 22 children had died over that period and the wakes that had on you. How do you how do you handle that pressure?

9.36 How Dr Umesh handles the pressure of patient safety

Dr Umesh:

Life itself is full of pressure and looking after children, very sick children, is actually pressurized job.

Today doctors work very hard, nurses work very hard, they look after very sick patients.

But if you can work with the doctors, if we can work with the nurses, no doctor, no nurse come to hospital to kill a patient to harm a patient.

So we got to understand the reason why patients are harmed.

Let me give you statistics. I'm very proud of the NHS, each year 360 million patients contact 1.3 million staff.

And each year, unfortunately, 20,000 patient die and forty-five thousand patients suffer more than six months of permanently disabled due to Medical mistakes.

When I say medical mistake, it is not because of bad doctors or bad nurses, it is because of our system or process in which most of these doctors who work like poor teamwork, poor IT, locum doctor - all these things add up to the mistakes which doctors make.

Look at Bawa Garba, hard-working doctor was working in Leicester.

A child died of sepsis, but she was not supported, completely broke down, consultant in support.

So these are the systems failure. It is wrong to blame one doctor, one nurse when there are systems failure.

So I have you know there are 22 children who have died in this country not even one should have died, and one of them is a seven-year-old girl who died somewhere in the Midlands.

The whole thing is tragedy.

Mother gives a very good history to the GP, first GP misses the diagnosis, second GP misses the diagnosis, mother goes to a teaching hospital where the junior doctor got the diagnosis, she wanted to admit the child.

Unfortunately overruled by the registrar, child was sent home and she became unconscious, five days later gets admitted to intensive care and coughs blood for 46 days and dies holding mother's arm.

I want you to feel the pain of that mother and three experts were telling lies. That broke the camel's back.

That was the 22nd child where I have you know opinion all these deaths are preventable.

It affected me. I was crying for a long time.

I went for a walk, I talk to my grandma when I'm very upset, so I was talking to her at the end of one hour I got an answer because I had a huge experience.

I decided to go somewhere and show how to transform, and went to work at Wigan and Leigh as a medical director.

It took me only six years to inspire everybody, motivate everybody and to work with the staff, work with the GPs, work with everybody and we reduced harm by 90% - I didn't do it, it's a wonderful staff who did it.

Liam:

Wonderful. Thank you.

I think I'm you know, obviously we just met today in person, but I'm starting to get an understanding of what's made the man and the profession in front of me.

So, if I've understood you right you said that you had those experiences and that the tragedy of those children and then you reflected and then a coach I know use the phrase and I'll tone it down for the sake of listeners, but something like turning, what is it again?

It's kind of turning manure into Dynamite, you know that you took that pain and you flipped it into a sort of transformational energy to do good.

So that's what made this man full of energy and power and influence has come from there.

So talk to us about how you set up to create tthis transformation, what was involved talk to us about the obstacles and roadblocks, because the end results sound great and exciting when I'm sure it wasn't straightforward!

13.47 How he transformed an organisation

Dr Umesh:

Let me first tell you, we reduced brain damage babies by 70% in Bury when I was a consultant.

I've been very lucky, I worked with some amazing people. My previous senior consultant had collected 18 babies with brain damage over 18 years.

I analyzed them and I realize some simple things if we turn it around we can reduce this harm.

So all I did was I called obstetric consultant I called midwife, we all sat around the table and we put robust governance.

All we did was remove the blame culture bullying fear of being very honest. We engage the families.

So to turn anything around you need, number one is a good leader. You need a good team in the department.

You need a good system, good process, good measurement and good culture. Today many staff are afraid to speak up because there's a culture of bullying.

There's a culture of blame, you know, I'll give you statistics. When I found out many doctors are suspended for one mistake by GMC.

If you do that, then doctors would be scared to speak the truth. If you bully stuff, they'd be scared to speak the truth.

What you need is an honest culture since your culture.

And having met many families I can tell you I was amazed at the family's forgiving nature.

Unfortunately, I have to meet many families in my job as a medical director.

Not even one family wanted me to dismiss a doctor or harm the doctor including a mother who lost her five-month-old child due to meningitis.

I met such wonderful people. I was holding her hand. I was crying, she was crying.

And she said, Dr. Prahbu, If you don't want to refer the doctor to GMC, please don't do it, but make sure no other mother goes through what I'm going through.

That is the type of people I have met in my life.

Their forgiving nature is what made me confident to be very open, very honest. So all public want is to be honest, all doctors and nurses will report honestly if we support them.

So in 1998 - 1995, we reduced brain damage babies in Bury by 70%. I give you a presentation on it.

So because of that I use the same experience in working at Wigan and Leigh. First week on the I told the staff we are going to make this the best hospital and I want you and each and every one of you I was going to help me and we are going to work together success, is when you all work together and let me tell you a quote from Henry Ford he says 'coming together is the beginning working together is progress winning together is a success'.

It is only when we work. And secondly, I've always believed patient must be at the heart of everything we do.

So I involved patient, I used to meet the complainants, I used to meet anyone who was not satisfied and by God, I learnt a lot and I was shocked.

My brother-in-law has got dementia, I wanted that hospital to be the best hospital in elderly care because if you know how to care for elderly care with dementia, with compassion, we know the heart of caring, and let me tell you this; Consultants, nurses, physical therapists, everybody work together and transformed it within 18 months and made it one of the best out of 14 hospitals.

So I owe a lot to wonderful staff.

What we got to do as a doctor, as a leader, is to work with them and remove the fear of bullying, fear of blame and support them, train them so that they can do a good job.

Liam:

Just reflecting on a few key points you made, you talked about patient layered, resident led.

I mean prior to moving to healthcare as I talked to you earlier about working for a company that went from a traditional business to a lien world-class, it was exactly the same principle.

It was starting with the recipient of the service find out what their needs are find out what they want, then re-engineer everything to meet those needs, then build a team to deliver those things, and it magically works.

Now you mentioned a couple of points earlier about systems, governance, right people leadership, you talked about reviewing the statistics on those 18 babies that had died and what you learn from it.

So my question to you, it sounds simple but not simple straightforward, but how did you know what those five points were?

How did you know how to take charge of that organization?

18.40 Taking charge of the organisation

Dr Umesh:

My experience comes because I would have broad experience.

I was natural advisor for poorly performing doctors. I've given advice to 300 medical directors and HR directors.

I saw tragedy after tragedy for doctors.

Also 1000 overseas doctors have contacted me when I was National Vice chairman of two big organization in this country for a very long time.

I've given a lot of lectures, I've written a lot and that's the reason why because people are seeing me in lectures and that that made me very strong.

I'll also provided training on communication skill for nearly 600 doctors because I love people.

I love taking a difficult person and change their thinking and make them a better human being.

I looked after 50 girls who were abused from the age of 3 years until 15 years.

When I see their pain mine is nothing, but I realized if you work with them, you win their trust, you can change anything.

That is the reason why all I did in Wigan is, there's a very good proverb, South African proverb. It says it takes a village to raise a child.

Success is never do to one or two individual you need a team of successful leaders.

All I did was appointed the Right leader to each and every Department. I asked four question to nurses, Junior doctors, GPS - who is a good consultant? Who's a nice human being? Who's a good team player? And whom do you want to see as a leader?

That is core human values, leader is a role model, everybody who gets on well with the person, and he or she has what a good communication skill and is a good team player.

And when I met these doctors 60% didn't want to be leaders but today three of them have become medical directors, because once you have the right values, all you do is train them very well and we provided eight days training and my plan is to launch that training for the country. It had fantastic training.

Number one is your behavior can impact on others.

I was not a good leader when I was medical director at Bury, I was managing doctors.

But then I studied Mahatma Gandhi, Nelson Mandela, Martin Luther King, I've also studied Hitler and Saddam Hussein.

I immediately realised what is leadership. One inspires, motivates people, help them, support them, unites them.

The other one oppresses them and suppresses them as a human being.

You have to deliberate their mind liberated mind is the most powerful mind. So once I pointed the Right leader, I started sending positive message.

And then I told the staff I'm here for you and 70 staff came to see me in confidence.

It is their courage which helped me to remove some of the bad doctors, bad managers, that is less than 1% of your staff - 99% want to do their best for their patients provided we can support.

Liam:

There's so many layers to what you're saying and obviously the sake of brevity you're making it very concise, but these are very complex to achieve in large organizations aren't they actually with so many people.

So I mean, having a being a sort of novice in healthcare for six/seven years, I've noticed the key determinant for me in healthcare organizations, it's simply that point you made.

There's either a strong blame culture or a week blame culture or something else, but most of the time it's degrees of blame.

You've talked about how you study leadership to understand how to influence, you've talked about how you set up talking to staff to get them to talk to you to kind of create a sense of engagement, but I'm still curious, especially for the NHS which is not a familiar organization me to work for in my sort of very narrow vision in my mind, the blame culture is so endemic in there.

I'm just amazed that you've you know in your time created a pocket where there wasn't a blame culture and I'm assuming that the senior people around you perpetuated the old culture.

So how on Earth did you bring those ideas in?

23.0:06 Values and leadership

Dr Umesh:

There's a very good quote which says fish rots from the head.

So my first challenge was to win the board, and I was able to do that without any problem because, I must thank Andrew Foster the chief executive and the chairman, both when I told them exactly my vision and plan, supported me fully and that is the most important thing.

Once I knew I won them over and we had feedback from each one of us about everyone else, and two of them were shocked the command they had from their own accord, and we then had a coach to change their behaviour.

Once we had the board, having the feedback, we translated that to all the senior leaders, all my Clinical Director.

I would send emails to 25 people, I just give the names and it goes to 25 people.

They give feedback about my behaviour. I don't know who says what but there are fantastic suggestions, positive and negative.

That is the way we change the behaviour. I'll challenge 59 consultants, that's exactly how I change their behaviour.

If you give early feedback before it becomes entrant Behavior, you can change people's mind. Once entering behaviour it takes a lot of time, lot of support.

So let me tell you Mahatma Gandhi's famous quote - he says 'don't lose faith in humanity, humanity is an ocean. A Few dirty drops do not make the ocean dirty.'

So the vast majority people come to work today do good job.

What 80-20 rule that is known as Pareto Principle, 80% of staff don't do any headache, 19% need help, support guidance, early feedback, and one person you have to dismiss.

That's exactly what we did. Once their leader is a role model, he leads from the front, he leads by example.

Once I asked the feedback of all my staff then they were empowered to take the feedback, and that is how we change the behaviour, it is known as the ripple effect.

A leader leads by example then everybody follows them.

What you need is a critical mass of good people. 10 good people can make the word best, 10 bad people can destroy the world.

So all I did was win over 80%, then took over the remaining 19%, and staff got confidence, they came and saw me and I was able to dismiss seven or eight people.

Liam:

Absolutely love that, that's really really fascinating.

Certainly reflects my modest experience in management where in a big team there might be noise from 10, but it turns out it's coming from one and then there's a few that get influenced and stuff like that.

So that sounds like 360-degree appraisals or performance systems in some ways. I've come across that and found that good.

I mean, what I love about that is it takes away the God complex from people with huge egos because just the fact that someone could comment on their behavior and then by asking a broad section of people you get a genuine consensus, don't you, you get a genuine reflection, because I've often found people who lack self-awareness can be the most harmful, harmful of all.

And I mean, you talked about the leadership leading from the front, I mean when we talked earlier you talked about values.

It sounds almost like you're saying that, I mean they're old-fashioned ideas, but sort of integrity and values driven and compassion and it sounds like you're making a case for those values to guide leaders in healthcare, is that right?

Dr Umesh:

Let me tell you where my values come from.

I come from a very poor family. My grandma brought me up and I was six years old, she told me always be honest, always be sincere, see good in others, do good to others, focus only on you, work hard, one day you may be somebody.

She was Mahatma Gandhi's follower. Her final advice was when you're doing something right don't be afraid of anyone.

So for a leader, honesty, sincerity, Integrity, courage all are important but reader must also be kind and great compassion for our fellow human beings. That is the most important quality which you need.

Then you can do anything in this world because of those values are very strong. I've always followed those values. I do not compromise my values.

I always believe it is my duty to respect you to understand your difficulty so that we can work together.

The togetherness is extremely important, unity and diversity is the most important.

Secondly, I owe a lot too many people who made me who I am today my professor of Paediatrics, she taught me how to look after children, she was the best paeds nurse in India, she was not married.

But the way she looks after the children, what I learned from her when I came here but many people supported me.

One of them is Mr. Philip bacon, who was my previous chief executive. What a wonderful gentleman. He devoted his life for NHS.

He would never waste NHS money and that is the type of people have worked. Values are most important, your values is what drives you, but you must make sure that other people they may not sign up to that values.

So you need a group of people who sign up to your values that is what I did in Wigan.

I appointed right leaders with the right values who was nominated by their own stuff with whom they work and that is the second important thing.

Third - staff engagement and patient engagement. We had fantastic stop engagement, fantastic patient and family engagement. Next most important robust governance.

Every Thursday I used to go through complaints, litigation Coroner's feedback, serious untoward incident or incidents. It used to be five hours meeting when I started by the time I finish it was only one-hour meeting because we are sorted usual suspect 10% of the Consultants.

We had sorted one by one, vast majority needed support.

You said something when you in the interview, you ask me lack of insight. I strongly believe it is not lack of insight.

We make them blind by not challenging them early. It is like a driving test.

You passed your driving test. You start jumping orange light and nobody catches you. You start jumping red light, eventually, it becomes a habit and that is what happens to most doctors and nurses whose behaviour deteriorates. They start off very slowly, gradually It becomes a pretty bad habit.

Liam:

I guess that sort of moves as quite nicely onto something I read in your writings about systems failures and how that links with blame and accountability and stuff like that, and I've got a little bit of understanding on that but I think it would be helpful if you could explain that really clearly to someone who doesn't understand what you're talking about, if you wouldn't mind.

30.36 System Failures

Dr Umesh:

That's a very good question. Let me do an example. You have a bad surgeon who doesn't know how to do surgery, then you can't blame the system.

First and foremost you have to look at why he was appointed. I had to dismiss a surgeon, 15 patients had died, everybody knew about it, but nobody had done anything about it.

That was in my first job as a medical doctor in Bury. I was asked to cover it up. I was shocked.

These are three wise men so called and they asked me to cover it up, and because I got a very strong values I don't put up with nonsense, I told them are you wise? Are you men? If it's your wife, what would you do?

So by the time I completed investigation 100 patients substandard treatment.

And he himself had a Cancer and nobody had supervised this work. That taught me a lot in 1998.

So when things go wrong, there are three fundamental reasons why things go wrong.

You have a bad doctor, there is nothing you can do, you have to sack him, but you have to prevent by assessing doctors performance.

The second reason good surgeon, but has a very bad team, bad equipment - who's fault is it? It is a system failure.

System must take responsibility.

In Wigan, I took the responsibility for system, anybody can come and see me if the equipment is not working.

I find the funding, I gave him the right equipment. I told that to the consultant first day to each and every staff if you make a mistake, you will be held to account, if the system makes a mistake I'll be accountable.

The third one is human factor. You got a surgeon overworking, stressed to start drinking alcohol.

That is a human fact.

So these are the three fundamental reason why patients are harmed. I had to dismiss a doctor who are sexually molesting patient.

I had to dismiss a doctor who was dealing drugs. I had to dismiss her doctor who was repeatedly telling lies.

I had to dismiss two Consultants many patients wrong diagnosis, but no Insight. All these things were brought to my attention by hard-working nurses and Junior doctor. It is their courage which transformed the trust.

All I did was empowered the nurses empowered the junior doctors and I told them for us today.

Please don't contact when it is too late and there is nothing I can do and I've seen many tragedies my aim is to protect the patient not to sack anybody.

But protecting patient is not negotiable because they are the most vulnerable people in all these things.

Liam:

I think I'm getting to understand it a bit.

So what you're saying is I think by making the culture more open these people, who day in day out know exactly where the vulnerabilities in the system are, they know it emboldened them to tell you and then you could take action so the culture, Shifting the culture meant that you could get that information and act upon it.

Okay, that's that's absolutely enlightening.

And the other thing reflecting on what you put in your writings quite a lot, which it can sound a bit flippant but it but I know it's not there's a real depth to it and it's very counterintuitive.

It's this idea of happy patients, happy staff.

You've got Richard Branson who explains the same point actually it was slightly different language.

He talks about looking after the customers by looking after his staff.

Now in my experience, much of the time organizations treat their customers well, but bizarrely they don't treat the staff well including managers, you know, I've had some good examples, but often organizations don't treat managers well at all for some strange reason.

So do you want to explain you're thinking as to why it's in the organization's interest to actually look after staff well?

34.52 Why staff happiness is important

Dr Umesh:

Happiness is a secret of success.

I'm a very happy go lucky chap, I always take things lightly. I've always said to my children; don't worry about the problem, think of the solution.

If we don't know how to solve talk to somebody who knows it. Most problems we can solve but there are some problems, the only solution is that is no solution, just get on with it.

I want to buy Buckingham Palace, Queen is not going to sell it, I can't afford it, but that is not realistic.

Vast majority of problems there is a solution and always realized if we make our staff happy a sense of belonging is the most important human sense.

If you don't have sense of belonging to the organization or the team, you do bare minimum, and that is what I realized in my all my various jobs I have done if you don't have sense of belonging to the country, belonging to the organization, belonging the team, you do not perform very well.

That is the reason why I wanted to create Joy at work or happiness. Happy staff, happy patient.

So most people know that client is very important, but they forget the staff who do all the work.

Let me tell you my own example where I learnt a lesson.

I had one of the best Junior doctors, she was very hardworking, very sincere. And for one year she worked with me.

I never praised her, I never thanked her.

One day she made a mistake with a child, child came to harm, I lost my cool, I told her off in front of the family that evening.

She taught me best lesson of my life.

She came to my office, she cried for one hour she told me, 'Dr. Prabhu, I worked with you for one year. You never praised me, never thanked me, but I made one mistake and you blasted me in front of the family and made me feel so small.'

I completely broke down, I cried.

That was the last time I gave anything like this to my junior doctors or to my staff.

That day onwards I changed my behavior; every Monday I would write nice email to my junior doctors, nurses.

I've seen several of your patients, I wish I could clock like that.

So I started giving positive feedback and I really had a fantastic reaction to that. I never had any difficulty in getting locums or Juniors love me and that is how we change the behavior.

If I want to give any negative feedback, I call them quietly to my office and discuss with them and why I think they could improve that is how you change the human behavior.

So happiness of the staff is extremely important. If your staff is stressed, if your staff is bullied, if you are staff is frightened, they will start making more and more mistake.

So that is the reason why happy mind is the calm mind and staff will be happy, if you engage them and value them, respect them, listen to them and understand their pain.

That is why staff engagement, patient engagement is so crucial.

That is how we transformed. For example, CQC visited the trust and found many mistake in medicine management. I was totally disappointed, but I spoke to the director of pharmacist and I'll tell you next two weeks what he did is an example of being a good leader.

He spent all this time in the world working with the nurses, looked at all the system, process, devised is a fantastic training program and put an audit and remember within six months all mistakes stopped and improved by 80 percent and the board got audit every month until we were convinced the habit was embedded.

They devise fantastic training for junior doctors and I can tell you I'm very proud to say one of the best in management is now in Wigan and Leigh.

Liam:

It sounds too good to be true, doesn't it?

But I think you're talking about how your junior staff needed to hear positives from you.

I came across a similar example in the last year where I thought a few staff working with me were being a bit uncooperative and I was looking at that way and actually got some feedback that perhaps I wasn't being as positive as I could be to them, maybe I wasn't giving them a few strokes and that and I got that feedback and I did it, and miraculously they changed in front of me.

But it's hard to remember isn't it, in the midst of a busy day with lots of pressures, but I'm fascinated to hear that that also actually did work for you.

I think the final thing I'd like to to think about and to hear from you would be for a private healthcare organization or it could be an NHS trust or a hospital manager possibly dealing in some of these cultures you've talked about which are low trust back covering.

What advice would you give them to to get started to embrace some of these values because it sounds like these values work. But what advice would you give?

40.11 Advice for other managers, junior doctors, nurses and the like

Dr Umesh:

Tomorrow I'm chairing a conference on how to be a good leader, how to be a good manager.

The first and foremost question to everybody is ask yourself, why do I want to be a manager? Why do I want to be a leader? Once you know that answer to that question then everything falls in place.

Mahatma Gandhi said 'be the change you want to see in the world. Your purpose drives you to do, once you know your purpose, once you know your values, why you want to be manager, why do you want to be a leader of any organization?

Why is the most important question. I asked a lot of time, why?

I have never done anything without asking myself why I want to be a medical director, and my dream is to make sure we have a fantastic Organization.

For that I have to take the team with me, that is the second. So how do I take my team with me?

It is sitting with them asking them their purpose and creating a common purpose.

You can only create common purpose, the ownership must be with each and every staff.

In Wigan we said patient safety is everybody's responsiblity, staff happiness is everybody's responsibility.

All I am here is to guide you, help you, support you, and get any funding or anything you need.

And NHS waste lot of money because of blame culture, bureaucracy, everything. Let me give you some statistics.

For bullying NHS fence two billion pounds a year. Medicine, we spend 17 billion.

We can save three billion out of those if we get medicine management right.

Good digitalisation - I saw in India some fantastic computers.

He does 700 cardiac operation a month, 500 cataract operation a day, and 35 major cardiac operations on children everyday, completely computerized.

He does cardiac operation for $1,000. So what we got to do is we have to subtract emergency, we have to separately ellective and we got to make elective very efficient.

We've got to invest a lot in emergency.

Today there are no beds in Social care patients are staying.

I recently gave a lecture last month last week about beds. We spent three billion pounds on beds.

If you all work together, if you get leadership, right, if you engage our staff, if you engage your patient and property if you get computerized digitalization, if you get skill mix right, we can transform this country and we can make our Healthcare and social care one of the safest and the best.

So to answer your question, first is to ask yourself why do you want to be a leader and manager?

Number two sit with the staff and tell them we are going to make this team on the best team, tell me how I can help.

That's the second.

Make it a common purpose, make sure everybody knows their responsibilities and duties and be there for your sauff when they are in difficulty.

The most important, staff are stressed, staff have family problems, staff have personal problems.

Nobody comes to do a bad job.

Your duty is to understand them, but you've got to remember you can't help everybody. I had to dismiss few staff.

I told first day to all our staff, first time I tell you nicely, second time I tell you nicely, third time I'll make it formal action and fourth time I have to say goodbye to you because I cannot let team suffer or patients suffer.

Drawing clear boundaries is extremely important, but I can show the mirror to you only if I am self disciplined.

The leader must be self-disciplined, leaders must have self-confidence and leader must lead by example, leader must be role model, others must see you as their their role model.

Then only they will respect you and your values will guide you.

Liam:

Thank you so much and I think I just want to leave the listeners to reflect on what you've shared because there's a lot there and I'm happy that we've got this medium of a podcast that people can hear it again because you know, there's what 40-odd years of experience wrapped up in what you said.

So I'm going to ask you I think of final question to close this, very appreciative of the time you've given.

So if you look back on when you first came into medicine, you look at the lifetime of work, how would you how would you summarize it for younger doctors and younger managers to pass on a bit of your wisdom from your experience?

Dr Umesh:

Life is the best teacher. Learn every day - the day you stop learning, there is the day you stopped living.

I'm very self-disciplined, I get up about four o'clock in the morning, even today I study.

Number two - respect everyone, value everyone, listen to everyone. You don't know who knows what.

It is that skill which really helped me. 70 staff took the courage to come and see me, and some of their courage - I would like to finish off by telling you a story.

One day I was about to go home on a Friday at seven o'clock. I was tired and two nurses were sitting outside.

And I told 'it's Friday, do you want to see me now?' They said 'yes, Dr. Prabhu'. I took them to my office. They were scared to speak, I've seen that before.

I knew something serious. I made them coffee so care for your staff making coffee is a small thing, but for them it matters a lot.

And then they relaxed a bit and they told me a story of a consultant who had made wrong diagnosis and they have been collecting it for nearly six months and nobody listened to them.

If only my colleagues had listened to them we could have prevented a tragedy for many patient.

So, my sincere advice to you - anything is possible, a winner is a dreamer who doesn't give up.

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Know you're dream, dream big. But don't dream only for you, dream for the whole Humanity.

Patient safety is a human rights issue.

One day we we all will be a patient. Number two - remember NHS is the best asset we have in this country, be proud of NHS, be proud of how social care, can be proud of our country's values.

It's all about working together growing together. I would like to finish off this interview with three quotes which are very favorite quotes.

Martin Luther King said 'our day begin to end the day we become silent about things that matter to us'.

Patient safety should matter to us. Staff happiness should matter to us.

Why we became healthcare workers should matter to us. So let us make our NHS safest and the best. Michelangelo said something beautifully.

I gave it to both my children. They have done very well. 'The greatest danger for most of us is not that our aim is too high and we miss it. It is too low and we reach it. We find our own comfort zone and blame others.'

Don't do that. Push your boundary a little bit. I'm a Maverick but everything I do, I do for Humanity, I do for patients.

Anything is possible if you work together if you put your heart and soul in it.

Finally, Mahatma Gandhi said 'keep your thoughts positive, they become your words. Keep your words positive, they become your behaviour. Keep your behaviour positive, they become your values. Keep your values positive, it becomes your destiny.'

So let us make our NHS our Healthcare safest and the best and together we can do it.

Liam:

So there you have it, the interview with Dr. Umesh Prabhu, a really very, very enjoyable interview for me. I did learn a lot. It was, I found it really fascinating how he achieved what he did.

When I reflect on the interview with Jeremy Wolford, which was the first episode you may have come across, Jeremy talked about how he had learnt from working in car plants, he'd learned leadership methodologies, one that didn't work one that did, and how he applied that to the Health Care environment turning over, turning around a nursing home and how from that fading nursing home he created Middleton Hall Village.

So talking to Dr. Umesh, I wondered where did he get these radical ideas from around communication and Leadership.

I wondered what the source was but it became clear the source was actually from his experience.

His experience of leading various Healthcare organizations and having to talk and investigate why things go wrong, having to apologize to families and doing I guess what I'd called root cause analysis about what are the fundamental issues that have led to this error.

So from, I think in some ways the cold face of experience he learnt what didn't work, you know, which would be communication silos, people not working together and I think he has a unique message about why we do need to work together in healthcare because it is a team game. For example in the hospital context, you know, the surgeons got to work with the people with him with the administrator, everyone's got to work together, everyone's got to communicate, otherwise, there might be an adverse outcome. And funnily enough it's the same in Care Homes.

Every person is equally important from the housekeeper, maintenance, the Cook, the carers, the managers.

All of them are equally important in providing a good experience for the resident and every person involved ensures that the provision of that service is sound, and I think Dr. Umesh just makes a great case for why we need to work together as a team, why we need to let go of silos and egos, and actually focus more on providing great care or a great patient experience.

So I do hope you enjoyed it as much as I did very sincere thanks to Dr. Umesh Parbhu.

Next up will be hearing from the very Dynamic Angela Fletcher of Happy Futures.

I met Angela late last week in Scarborough. She showed me around her facility, really really fascinating leader, very successful Health Care, social care entrepreneur with a real heart and a passion for those she serves.

I got a great deal from meeting her, meeting her team and seeing how it can be done, so more to follow on that.

Listen to more episodes

• Care Home Quality Podcast - episode 1 with Jeremy Walford, CEO of Middleton Hall

Care Home Quality Podcast - episode 2 with Samuel Barrington, CEO of Care Improvement Associates

Care Home Quality Podcast - episode 3 with Dr. Keren Wilson, the pioneer of Retirement Villages

Care Home Quality Podcast - episode 4 with author and recruitment specialist, Neil Eastwood

Care Home Quality Podcast - episode 5 with Isaac Theopholis, author of 'How to get Outstanding'

Who is Liam Palmer?

Liam has authored two books about care home management.

He is an advocate of raising standards in social care through developing leadership skills, and he has worked in many healthcare and care home settings.

In this podcast series, backed by Nurses.co.uk, Liam interviews inspirational social care and care home leaders and innovators.

Who is Dr Umesh Prabhu?

Dr Umesh Prabhu is currently a Medical Director, after working as a Paediatric Consultant and Clinical Director.

He graduated in India and has worked in the UK since 1982.

He firmly believes that patient safety and supporting staff are just as important as each other and dedicates his career to this.

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About the author

  • Liam Palmer
    Registered Home Manager

Liam Palmer is the author of 2 books on raising quality standards in care homes through developing leadership skills. The 2nd is called "Leadership Secrets of Care Home Managers” inspired by several meetings with the Chief Inspector of the regulator, the CQC. Liam has been fortunate to work as a senior manager across many healthcare brands including a large private hospital, a large retirement village and medium to large care homes in the private sector and 3rd sector.

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About the author

  • Liam Palmer
    Registered Home Manager

Liam Palmer is the author of 2 books on raising quality standards in care homes through developing leadership skills. The 2nd is called "Leadership Secrets of Care Home Managers” inspired by several meetings with the Chief Inspector of the regulator, the CQC. Liam has been fortunate to work as a senior manager across many healthcare brands including a large private hospital, a large retirement village and medium to large care homes in the private sector and 3rd sector.