Is a ‘can do’ attitude a problem? Sir Robert Francis thinks it is

I am always drawn to the counterintuitive and this statement from Sir Robert Francis stopped me in my tracks. He was responding to a question from James Naughtie on the Today programme about what attitudes have to go to put things right in the NHS. He said the ‘can do’ attitude has to go.

To put this in context, it was an interview about the recent Care Quality Commission allegations. The discussion had moved on to the enormity of the task that the Care Quality Commission had been set and the constant change in its functions. He had said that “the challenge for government and, in particular, politicians is to come to the recognition that health care is never going to be perfect and it is therefore not productive to pretend it can be.” This then led on to the question about what has to go and Sir Robert said “the attitude which pretends that everything can be done with, what’s called in the system, a can do attitude”.

” Health care is never going to be perfect and it is therefore not productive to pretend it can be” Sir Robert Francis

I have never before felt that a ‘can do’ attitude was wrong. Indeed, to say it ‘has to go’ is a very strong statement. I can see his reasoning, that if those working in the NHS just keep on trying to ‘can do’ when resources or poor organisational practices work against them, then nothing will get flagged up or changed. Or it may be that a ‘can do’ attitude can lead to pushing through with a change that people are not ready for, or may be misguided, or just plain wrong.

Yet I cannot help thinking that it is only through the efforts of people who have a ‘can do’ attitude that improvements against the odds are made. All change is hard; all innovation requires people to go outside their comfort zone. I believe a ‘can do’ attitude is needed to change established norms and culture where reluctance to change can easily be disguised as avoidance of risk or harm. However, it is not about heroic, blind faith that it will all turn out alright in the end or that it doesn’t matter what gets lost or broken as all eyes fix on the prize. Good risk management, listening carefully to the doubters, thinking and rethinking the what, the how and the when – all these are important. One of my favourite sayings is: the most important person in the room is the one who disagrees with you.

“All change is hard; all innovation requires people to go outside their comfort zone”

I hesitate to disagree with Sir Robert Francis so I have come up with proposed areas of common ground

  1. A ‘can do’ attitude can reinforce the idea that everything can be done which then leaves the way open for media and public criticism when some bit did not get done. To mitigate against this openness and honesty about limitations are needed.
  2. A ‘can do’ attitude can mask problems in working practices and expectations that should otherwise be addressed. To mitigate against this robust feedback processes are needed and the management must be prepared to listen.
  3. A ‘can do’ attitude to change should be tempered by a relentless focus on people and the impact of the change on them and by openness and honesty when things have not gone well.
  4. A ‘can do’ attitude is acceptable when it reflects a shared commitment to change on the basis that it will bring better value from a number of perspectives.

On the assumption that Sir Robert would accept these, I will continue to have a ‘can do’ attitude.

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