CHANGE HERE
The NHS, with 1.7 million employees, is the world’s fifth largest employer, after the American and Chinese military, Walmart, and McDonald’s. However, unlike armies and chain stores, one of the hallmarks of the NHS is variation and inconsistency — in procedures, practices, and outcomes — and uniform and systemic change is difficult to initiate and sustain. Yet change has also been one of the constant features of the NHS, and further changes are essential if it is to survive. Two recent reports, by Professor Sir Bruce Keogh1 and Professor Don Berwick,2 in the wake of the Francis report and other alarm signals, emphasise the need for large-scale, trans-organisational changes, and also highlight the vulnerability of medium-sized organisations within the NHS, such as hospital trusts, to the failings and foibles of individuals in clinical …