Improving the CHI

L. Patterson and J. Cornwall

Commission for Health Improvement, Finsbury Tower, 103-105 Bunhill Row, London ECIY 8TG, UK

Professor Burns (2002) makes some good points in his article on the Commission for Health Improvement (CHI). The CHI is a relatively new organisation and is constantly learning. Already, many of the suggestions for change to our clinical governance review process made in his article have been identified and implemented through our own processes of self-review and improvement. Such improvements include shortened clinical governance reviews and shorter, more accessible reports.

However, Professor Burns unfairly doubts the experience of CHI reviewers who undergo a rigorous assessment and training programme. He also questions the consistency of clinical governance review reports. We have developed assessment frameworks to help review managers, and reviewers make reliable and consistent assessments transparent to both the organisation and its stakeholders. This framework underpins the entire process, driving the collection of data and information and all reporting arrangements.

Professor Burns also makes unhelpful comparisons between homicide inquiries and CHI reviews. Our role is not to identify individuals to whom blame can be attributed, but to help encourage improvement where improvement can be made. Many have found CHI's reviews a positive experience enabling the organisation to recognise strengths as well as weaknesses. In the meantime, the CHI is committed to learning and improving our own systems through constant consultation. Feedback is always welcome; even better, why not become a CHI reviewer and make your own contribution?

EDITED BY KHALIDA ISMAIL

Declaration of interest

L.P. is Medical Director and J.C. is Director of Policy and Development at the CHI.

REFERENCES

Burns, T. (2002) The Commission for Health Improvement (CHI) review of North Birmingham Mental Health Trust: what can we hope for from the CHI? British Journal of Psychiatry, 180, 6-7.[Free Full Text]


 

Author's reply

T. Burns

Department of Psychiatry, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK

EDITED BY KHALIDA ISMAIL

I am delighted that the CHI has identified similar improvements through its internal monitoring as I suggested in my editorial. I was trying to be helpful.

I did not question the assessment and training of CHI reviewers but their experience as reviewers. Obviously, CHI is new and so its current reviewers are new. A useful exercise at 2 years or so would be to report the average number of reviews conducted by members and to check the number where the seconded members are all first-timers. How comparable and consistent the reports are is also a judgement of outcome, not just of process. Stake-holders will make their own judgements — probably in the same way I did by reading a couple side by side and trying to compare and contrast. Time will tell but shorter reports will certainly help.

Linda Patterson's and Jocelyn Cornwall's comments on my ‘unhelpful comparisons’ with homicide inquiries do, however, warrant a reply. Homicide inquiry panels would also consider their aim to be ‘to help encourage improvement where improvement can be made’. The point I was trying to make is that there can be a gulf between this wholly admirable ambition and the impact of such reports (and that this impact is both direct and indirect through the media).

This point is being made infinitely more eloquently by the Cambridge University philosopher Onora O'Neill in the BBC Reith Lectures entitled ‘A question of trust’ (O'Neill, 2002). In these she analyses with devastating precision how a pursuit of accountability and transparency at all costs can, and does, lead to the erosion of trust and, paradoxically, a reduction in disclosure and honest communication.

Having started my psychiatric training at a time when consultants really did seem free to do exactly what they wanted, I warmly welcome review and the establishment of consistent standards of clinical care. However, the age of innocence is surely passed. Professor O'Neill's analysis is a call to more careful thought on how accountability and transparency can be achieved without damaging the process they are meant to foster. Hopefully, now it will be accepted that we can have a debate on these issues without it being seen simply as protectionism. I wish the CHI well.

REFERENCES

O'Neill, O. (2002) A Question of Trust. Cambridge: Cambridge University Press.