People enter the NHS wanting to prioritise the quality of patient care but become bogged down by operational and financial management. Photograph: Getty Few healthcare managers care that the Berwick report says many things we know already. The policy wonks and commentators who have had little moans about "nothing new in Berwick" are part of a longstanding problem that bedevils the NHS: the unhealthy desire for novelty. Managers (and other staff) don't want new structures, rules or strategies; managers want Terry Leahy-style consistency.
What really matters is that someone of huge stature has delivered another considered, mature report – following Bruce Keogh's clear message last month. Who delivers the message is as important as what they say. Few shine brighter in the healthcare firmament than Don Berwick.
When Berwick endorses the NHS – in ringing tones – as a unified system of healthcare which we must cherish, we should be encouraged. When he says we must abandon the use of blame as a tool, and instead "trust the goodwill and good intentions of the staff", and build a culture of learning, we should sit up and act, especially politicians and senior policymakers. When he says criminal sanctions should only be used in cases of "wilful, reckless behaviour or neglect", we should agree and avoid getting sidetracked by new legal sanctions.
Yet again the message that culture and engagement of staff and patients is crucial comes through loud and clear. As the report states: "In the end, culture will trump rules, standards and control strategies every single time …"
But Berwick is clear about the challenges we face in the NHS and suggests four guiding principles to inform every step we take. These are good not just for the so-called front line of care and here is how managers should respond:
1. "Place the quality and safety of patient care above all other aims for the NHS …" No manager enters the NHS not wanting to do this, but, until relatively recently, operational and financial management has often been prioritised by politicians and policymakers. The new quality agenda will inevitably slow movement on finances and operational targets (eg expect the NHS Trust Development Authority to live on beyond 2016) but this will take nerve from Whitehall to boards.
2. "Engage, empower, and hear patients and carers throughout the entire system, and at all times." I regularly speak to chief executives who place staff engagement at the heart of their professional practice or who spend up to a fifth of their working week considering and responding to complaints from patients and their families. But these skills are not easily acquired or developed in a system that has tended to place highest value on what is done, rather than how it is done.
3. "Foster wholeheartedly the growth and development of all staff, especially with regard to their ability and opportunity to improve the processes within which they work." Managers, together with other elements of the healthcare workforce, especially clinical support staff, need greater investment in their skills and development career-long. Much more is needed if they are to learn, master and apply modern methods for quality control, quality improvement and quality planning.
4. "Insist upon, and model in your own work, thorough and unequivocal transparency, in the service of accountability, trust, and the growth of knowledge." Too many people are in charge, which often means no one is in charge. Managers deserve clearer definition of their responsibility for safety and improvement and they want accountability and openness that is fair and robust not a cynical exercise to find a scapegoat.
Finally, Berwick instructs us to "Make sure pride and joy in work, not fear, infuse the NHS." This may be nothing new, but every member of Managers in Partnership will embrace it.
Jon Restell is chief executive of Managers in Partnership
This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.
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