What’s the link between fatal hospital infections, Olympic cycling champions and the humble teddy bear? According to former chief medical officer for Scotland Sir Harry Burns, they all point the way to making dramatic improvements in Scottish education.
Sir Harry has told TESS that a pioneering public health programme – credited with saving 20,000 lives – can show how controversial plans for standardised tests in Scottish schools could succeed. He also believes that the plans, which have faced vehement opposition from teaching unions, should be used in a way that emulates the system that turned the British cycling team from also-rans into world-beaters.
Sir Harry, now professor of global public health at the University of Strathclyde, highlighted the groundbreaking Scottish Patient Safety Programme (SPSP, see box, below) as a model that could help to close Scotland’s stubborn attainment gap.
SPSP began in 2008, combining rigorous analysis of health data with the application of hospital staff’s own ideas of how to improve patient safety. Earlier this year, it emerged that since SPSP started, there had been about 20,000 fewer deaths in hospitals than would otherwise have been expected.
Sir Harry sees parallels between initial scepticism around SPSP (“People said it would never work”), and disquiet over standardised national assessment, which will be introduced in pilot projects next year for pupils in P1, P4, P7 and S3. But he believes the accrued nationwide data could help to drive up standards in education, as long as teachers buy into the system and are trusted to decide how the data could help pupils – although he conceded that teachers are unlikely ever to become “wildly enthusiastic” about a testing regime.
“Data should be used for improvement, not for judgement,” Sir Harry said. “If you get data that shows you’re not as good as all the other teachers in the school, that information should be used to help you get better, not to feel that you’re at the bottom of a league table – because that just destroys your confidence and makes you worse.”
The changes in hospitals post-SPSP were often dramatic: in intensive care units it used to be “almost inevitable” that patients would get certain infections if they stayed long enough, according to Sir Harry; now, in some hospitals, there have been no cases of those same infections for about two years.
Change like this could not be achieved in any complex system – health or otherwise – through “one big idea”, he stressed, but rather through “doing lots of things that work and making small changes that together add up to big changes”.
The same principle had been applied by Great Britain’s hugely successful cycling team, whose former performance director, Sir Dave Brailsford, talked about “the aggregation of marginal gains”. By making dozens of small improvements, Sir Harry said, “they went from being nowhere to the best in the world”.
The most outstanding successes of SPSP occurred where doctors and nurses were consistently encouraged to decide how lessons from data could be put into practice.
“You can’t expect people to be committed to changes if they haven’t had any say in shaping them,” he said. “Big ideas, like (standardised) testing, and so on, may well be important, but if they are seen in isolation and they are resisted by the teachers, then nothing is going to change.”
Sir Harry, who over the years has addressed educators about the lifelong harm done to brain development in infants brought up in chaotic homes, also pointed to the success of the national Early Years Collaborative (EYC) scheme since its launch in 2012. The project – described as “the world’s first multi-agency, bottom-up quality-improvement programme to support the transformation of early years” – has contributed to an 18 per cent fall in stillbirth rates and a 15 per cent drop in infant mortality; by the end of this year, the potential benefits to education will start to emerge when developmental progress is measured.
“I would never have anticipated that the improvement that’s taken place would have been so profound,” Sir Harry said.
EYC, like SPSP, encourages testing of small, locally driven ideas. One example cited as best practice came from nurseries that asked children if they were being read bedtime stories. Books were then handed out to parents at hometime, along with evidence about the benefits of bedtime stories and an incentive: a teddy called Bedtime Bear who, children were told, needed a story every night. This helped speech development and attachment, with potentially many more knock-on benefits.
EYC, Sir Harry said, along with the similarly groundbreaking SPSP, showed the potential for results if data is used to harness ideas from people on the ground, whether nursery staff, doctors, nurses or teachers.
Sir Harry added: “What emerges is always something you would never have thought about – you always get much more creative outcomes and ideas than you anticipate.”
How the Scottish Patient Safety Programme won staff over
The Scottish Patient Safety Programme (SPSP) was billed as the first such national programme in the world on its launch in 2008. The fundamental aim was to reduce avoidable harm to patients by improving safety at every single stage of the care process.
SPSP – which began in acute, hospital-based care and has expanded into maternity services, community services and mental health – hones what Sir Harry calls the “science of improvement”.
Staff are asked what changes they would make; their ideas are then tested to yield data that is meticulously analysed. Innovations deemed successful are applied consistently across Scotland.
The approach was not universally welcomed by health professionals – some argued that they were already doing all that they should be, but could not provide the data to back that up – although Sir Harry sees no opposition now.
The programme reduced mortality rates in 24 of 29 hospitals in its first eight years. The overall hospitality mortality rate fell by 16.5 per cent, although that fell short of a target of 20 per cent.