Encouraging openness in health care: Policy and practice implications of a mixed-methods study in the English National Health Service


Objective The National Health Service (NHS) in England has introduced a range of policy measures aimed at fostering greater openness, transparency and candour about quality and safety. We draw on the findings of an evaluation of the implementation of these policies in NHS organisations, with the aim of identifying key implications for policy and practice. Methods We undertook a mixed-methods policy evaluation, comprising four substudies: a longitudinal analysis of data from surveys of NHS staff and service users; interviews with senior stakeholders in NHS provider organisations and the wider system; a survey of board members of NHS provider organisations and organisational case studies across acute, community and mental health, and ambulance services. Results Our findings indicate a mixed picture of progress towards improving openness in NHS organisations, influenced by organisational history and memories of past efforts, and complicated by organisational heterogeneity. We identify four features that appear to be necessary conditions for sustained progress in improving openness: (1) authentic integration into organisational mission is crucial in making openness a day-to-day concern; (2) functional and effective administrative systems are vital; (3) these systems must be leavened by flexibility and sensitivity in implementation and (4) a spirit of continuous inquiry, learning and improvement is required to avoid the fallacy that advancing openness can be reduced to a time-limited project. We also identify four persistent challenges in consolidating and sustaining improvement: (1) a reliance on goodwill and discretionary effort; (2) caring for staff, patients and relatives who seek openness; (3) the limits of values-driven approaches on their own and (4) the continued marginality of patients, carers and families. Conclusions Variation in policy implementation offers important lessons on how organisations can better deliver openness, transparency and candour. These lessons highlight practical actions for policymakers, managers and senior clinicians.

Publication DOI: https://doi.org/10.1177/13558196221109053
Divisions: College of Business and Social Sciences > Aston Business School > Aston India Centre for Applied Research
College of Business and Social Sciences > Aston Business School
Additional Information: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Uncontrolled Keywords: culture,openness,quality and safety,Health Policy,Public Health, Environmental and Occupational Health
Publication ISSN: 1758-1060
Last Modified: 24 Apr 2024 07:22
Date Deposited: 28 Jun 2022 11:48
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Related URLs: https://journal ... 558196221109053 (Publisher URL)
PURE Output Type: Article
Published Date: 2023-01
Published Online Date: 2022-06-22
Accepted Date: 2022-06-01
Authors: Martin, Graham
Chew, Sarah
McCarthy, Imelda (ORCID Profile 0000-0002-4715-9831)
Dawson, Jeremy
Dixon Woods, Mary


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