Ex-CEO of England's National Health Service visits Pittsburgh

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Sir David Nicholson feels Eric Shinseki’s frustration.

Mr. Shinseki, former secretary of the U.S. Department of Veterans Affairs, resigned last month in the midst of a blooming scandal involving long wait times and “secret” appointment lists at VA hospitals and clinics.

Mr. Nicholson can relate. As the former CEO of England’s National Health Service, the world’s largest single-payer health system, he knows what can happen when employees and management become focused on the wrong goals.

At times, “We got so obsessed with the mechanism [of providing care] that we took our eyes off what is most important, which is improving service for patients.”

Mr. Nicholson is in Pittsburgh for the weekend, and this morning delivered the keynote address at the “All Together Better Health” conference, hosted by the University of Pittsburgh and The National Center for Interprofessional Practice and Education.

Conference speakers are presenting the latest research on interprofessionalism and team-based medicine, which are key elements of the so-called “patient center medical home” model of care.

Mr. Nicholson — an National Health Service “lifer” who spent 36 years at the $170 billion British agency, seven of those as CEO — retired in March. His retirement came under heavy media pressure following a scandal at Stafford Hospital, where poor emergency and clinical care and “appalling conditions” may have cost hundreds of patients their lives, according to media accounts.

Mr. Nicholson was in charge of the regional health authority supervising Stafford hospital for two years, before being appointed NHS CEO in 2007. As chief executive, he was accused of being late to recognize the scandal and then, not taking it seriously. In British media accounts, he called that experience a matter of “bitter regret.”

At large organizations, such as the NHS or the VA, “there’s always that danger” that those sitting at the top of the organization don’t know what’s happening below them, he said.

“Inevitably in a large statewide organization, there is an element of bureaucracy,” Mr. Nicholson said. It’s one the reasons, he’s a believer in constant, real-time patient polling and monitoring. Immediate feedback from patients, as well as ground-level clinical staff, can head off long-term, institutional problems.

“You need to [link] patients to the top,” he said. “If you don’t, [you] can become out of touch ... you can game the system.”

And gaming the system to disguise mortality rates, or make it appear as if waiting lists are smaller than they actually are, might help managers earn their bonuses but it doesn’t benefit the patient.

“Quality [must be] the organizing principal for health care,” he said. “The way to deal with that is to ensure that the organizations are led by people [who] aren’t spending their time feeding the beast” bad information and data.

As someone who comes from a single-payer system, Mr. Nicholson said he “can’t imagine what it’s like to begin to navigate” an American system that has hundreds of insurers and a collection of independent hospitals, physicians and clinics that don’t always share patient data with each other.

But he also pointed to Pittsburgh as an example of a city that manages to bring important components of the health industry — research, insurance, education and delivery — under one geographic roof.

There are obviously advantages in that type of cooperation and synergy, he said.

“Unless you get all of those things lined up, you simply don’t get the best outcomes for patient,” he said. “You create obstacles for yourself every time you create a hand-off” from one clinician to another.

Bill Toland: btoland@post-gazette.com or 412-263-2625.


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