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Dinesh Perera PCQI is a quality auditor for the Health & Wellbeing department of business outsourcing giant Capita.
Dinesh enforces civil service quality standards and NICE guidelines for the Department of Work and Pensions (a Capita client) by evaluating clinical disability assessment reports.
Dinesh also has a working background in nursing and mental health care.
We interviewed him about the role of lean quality in healthcare, and the future of the NHS and occupational mental health.
Qualsys: You've done a lot of work educating yourself about quality over the past few years. You've joined the CQI and taken a keen interest in ISO and lean methodologies.
Is that an occupational move to change things at Capita, or a personal journey?
Dinesh: It's a bit of both.
Because Capita fulfils contracts for the government, the government sets out our quality criteria.
That means our QMS is a bit of a hodgepodge and we aren't explicitly governed by ISO 9001.
I have a personal interest in quality management. I'm trying to promote ISO to senior management.
So although there isn't much scope at the moment for things like lean and ISO in my role, I want that to change and to progress to more of a fully-fledged auditor.
Qualsys: Do you think quality has more to offer in a general way to how we manage things like disability and healthcare in the U.K.?
Dinesh: From what I saw in the NHS, for sure.
The NHS is the largest employer in the country, as a result it's very fragmented geographically and in terms of quality.
Because of things like cyber security, elements like IT teams do buy into quality management. And external suppliers of things like surgical equipment need to follow ISO standards.
But for the day-to-day, bread-and-butter running of areas like accident and emergency and clinical procedures, there's no standardised QMS.
I think clinical accidents, incidents and negligence largely come down to that fact.
The NHS keeps crying out for more spending and the government keeps increasing spend, but the problems are still there.
I think that goes to show there's a good case for going lean.
There is a move happening to change things.
But as things stand, if you were to ask a nurse or domestic staff member on an NHS ward about lean or quality management, they wouldn't know much about it.
Qualsys: Do you think there's scope for things like lean techniques to be applied to the NHS?
Dinesh: There is a growing interest in that. The Virginia Mason Institute in the U.S. specialises in lean healthcare improvement, and some NHS organisations have gone into partnership with it.
The Institute is educating high-level clinicians, nurse managers and practitioners in lean.
Think of something like A&E waiting times, that come up in the press again and again. Or the winter flu crisis or the bed crisis. Over the past 10 years, these recurring problems have arisen.
The NHS saw its worst ever A&E performance figures in December 2019
The NHS keeps crying out for more spending and the government keeps increasing spend, but the problems are still there. I think that goes to show there's a good case for going lean.
And I think there is an appetite now for that.
I also think bringing in some private providers and growing competition would be good for the NHS.
Qualsys: The interaction of privatisation and the NHS is always a hot topic, particularly at election time. Do you think private enterprises have a role to play in healthcare quality?
Dinesh: Unless you have a vested interest in profit or losing a contract, you're not going to be worried about things like lean techniques, efficiency and so on.
That's been the problem with the NHS. Nobody has taken responsibility.
Some healthcare trusts are starting to look at quality management while remaining wary of private influence. But I think it's a good thing.
Without bringing in competition and putting pressure on trusts to change their clinical governance, without using that stick, I don't think you'll ever see change.
It's up to the government, to the unions, to nurses to take ownership and change thinking. And it's up to the taxpayers to think how the NHS can best spend our money.
Qualsys: You have a lot of mental healthcare experience.
We hosted an ISO 45001 event in Sheffield last year. One of our speakers who sat on the committee mentioned ISO 45003, the psychological health and safety guidelines which are in development.
If ISO 45003 ever goes live, what do you think businesses will have to start doing to safeguard their employees' mental health?
Dinesh: The Institute of Internal Auditors had a recent article in their magazine about the geopolitical trends that would impact businesses in 2020.
One of the key areas they identified was mental health of staff.
This is something I see every day as people are performance-managed and set targets. It can be pretty cutthroat.
Auditors are used to picking up on risks like climate change, cyber threats, terrorism and so on.
But there isn't an honest discussion about how mental health can affect things in a business.
The way businesses run performance management frameworks is a big hurdle for mental health.
Flexible working is a great way to make a difference. For instance, I can work remotely from home for a couple of days a week.
If you have a family member in crisis or with a long-term health condition, you probably want to stay in work to support them, and businesses aren't always flexible around that. So there's a lot to be done in that area to maintain the wellbeing of staff.
I think technology is important for this too, by providing staff with as many ways to work as possible. Using technology, I can work remotely, in the office or at home. So that can take pressure off people.
Balancing work with family life is important. A lot of businesses say something like, "We don't want to hear about your problems, you said you could do this job."
But life isn't like that! We don't operate in a vacuum.
Auditors are used to picking up on risks like climate change, cyber threats, terrorism and so on. But there isn't an honest discussion about how mental health can affect things in a business. Most of us assume that we're tough and resilient, until a crisis comes along.
There's no common understanding or common policy yet, and no consensus among developed nations.
Just a focus on "if someone gets hurt, we'll fix it."
They think when you talk mental health, you mean mental illness. But wellbeing is a much broader agenda.
1 in 4 people are going through emotional difficulties at any one time, and we haven't done enough to address that.
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