Civil service leaders must get better at deep listening

Does it bother you as much as it does me that across government, we can still be way too slow to spot and act on serious problems before they materialise or grow into national scandals?
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By Dame Una O’Brien

02 May 2024


When inquiry reports land this year into the Grenfell fire and the infected blood scandal, findings could indicate that government organisations knew early on of serious risks yet failed to act. Knowing and not acting – or even worse, covering up a poor or non-response – should never be part of our public institutions. But what about a different scenario? One where, say, a government department receives multiple single items of information dropping over time into a sea of incoming correspondence. How do we learn to spot weak signals and draw out patterns of mounting problems?

On the day back in 2012 that I gave evidence to the Mid-Staffs public inquiry, the short journey from London to Stafford was in sharp contrast to the time it had taken for the extent of patient neglect at Mid-Staffordshire NHS Foundation Trust to fully register in the Department of Health.

Yet the truth was with us all along: I carried with me copies of documents the department had submitted to the inquiry, including numerous letters and emails sent over the years from patients on the wards in Stafford, and their visitors, about something worrying they’d experienced or seen. So worrying they’d gone to the trouble to tell us. A good number had come via local MPs. And many pointed to the issues that eventually culminated in the breakdown in care. Uncovered from amongst hundreds of thousands of items of correspondence, we hadn’t linked these together; no one person or system had joined the dots.

The replies were telling. Often signed by officials or ministers, they rarely addressed, or even ignored, the specific concerns. Instead they gave well-intentioned explanations of policies and initiatives underway to improve the quality of care.

This evidence, for me, was a moment of reckoning. Could we have seen and heard those concerns sooner? If so, were we equipped to respond before matters deteriorated further? The answer, of course, is that we should have been far more alert to what was going on; yet given the systems and culture at the time, that clearly took too long. All this, by the way, was when the department was consistently rated a “best performer” in Whitehall for its swift handling of correspondence.

A lot had to be changed after the Mid-Staffs inquiry reported in 2013, starting with acting on information from the public. We introduced a triage system for incoming emails and correspondence, making sure that witness or bystander accounts of unacceptable and neglectful care were singled out. New arrangements were made to pass information to the independent regulator, who by then had a system for surveillance and inspection of hospitals. To drive cultural change, senior officials were, for several years, required to spend time each month on the service front line, getting up close to the sorts of issues and concerns encountered by patients and staff.

Does it bother you as much as it does me that across government, we can still be way too slow to spot and act on serious problems before they materialise or grow into national scandals? Surely this is a place where AI and machine learning can help with problem seeking, helping to expose hidden patterns of concern.

Change, though, also starts with individuals. We could all do more to really listen to people who are at the receiving end of our decisions and actions. Here are some angles I’ve learned from experience:

  • Ask questions, work to clarify shared facts, get a third party view
  • Try articulating the other person’s perspective
  • Don’t automatically assume the worst (that people are making it up, exaggerating for personal gain or trying to cover up their own shortcomings)
  • Be wary of projecting new information onto a pattern of past events 
  • If you must assume, assume positive intentions
  • Probe with humility, not defensiveness or aggression. Ask: “What is it you haven’t yet said that you want us to know?”

This is difficult work, even counter-cultural, as businessman Ram Charan wrote over a decade ago in the Harvard Business Review: “There is a reason that, over the years, you have lost your ability to listen. It feels too passive, like the opposite of action. It’s much faster to move to a decision based on the information you already have…. It takes time to truly hear someone and to replay the essence of their thoughts back [to] them so that both parties are clear on what was said. The payback is dramatic, but it comes over the long run.”

Dame Una O’Brien is a leadership coach with the Praesta partnership and a former permanent secretary at the Department of Health

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