The achievements of Jocelyn Cornwell in improving patient experience
08 January 2021
Richard Smith, Bev Fitzsimons and Sir Robert Francis reflect on the impact of our founder, Jocelyn Cornwell, on the creation and development of the Point of Care Foundation.
Jocelyn Cornwell has stepped down from her position as chief executive of the Point of Care Foundation, which she began as a programme within the King’s Fund in 2007. In a powerful accompanying article, she describes her journey with the Foundation, while here we reflect on her achievements. The thinking of all three of us has been strongly influenced by Jocelyn.
The mission of the Foundation is to humanise health care, and its vision is a “Radical improvement in the way we care and are cared for.” Nobody has done more than Jocelyn to try and achieve that vision, but, as she makes clear in her article, there is a way to go.
Jocelyn’s passion to achieve the vision was ignited by her anger at how people in mental health hospitals were treated when she worked as a care assistant while a teenager. But it was the mismanagement of the birth of her youngest nephew, who remains severely disabled, that prompted her to create the Foundation. Her passion has not abated with time and is rooted in a deep-seated opposition to inequality and misuse of power. Throughout her career she has emphasised the importance of relationships, emotion, empathy, and kindness. She is with Atul Gawande, the Boston surgeon and author, in believing that “retaining the autonomy to be the authors of our own fate . . . is the very marrow of being human.”
In her book Hard Earned Lives (1985), which was based on her PhD and describes lay beliefs about health, illness, and medicine, she began to set her course to humanise care. Her work contributed to the body of knowledge about how to move beyond public to private accounts of their experiences. It is still relevant today when you consider the trend toward gathering superficial real-time feedback, compared to the importance of getting “under the skin” of people’s stories.
Storytelling became central to the work of the Point of Care Foundation, and the best illustration may be the story of Kieran Sweeney, a friend of Jocelyn and a general practitioner who learnt about his diagnosis of the cancer that killed him from reading the hospital discharge note that also said “Patient is aware of the diagnosis.” The foundation has a programme named after Kieran.
Jocelyn built her understanding of health care, the NHS, and the politics of health through her work as an NHS manager, in the Department of Health, with the Audit Commission, and as the chief executive of the Commission for Health Improvement. Every job she had was one that didn’t exist before and developed her capacity as an innovator. Her friend and long time mentor, Dame Deirdre Hine, says: “In each of the roles that I have known Jocelyn she has devoted her personal qualities of intelligence, energy and sensitivity to improving the quality of healthcare given to patients with great effect. She has also used them in giving superb support and encouragement to colleagues, especially women.” Her colleague Peter Homa describes Jocelyn’s exceptional ability to translate high level concepts into practical reality that makes a difference for patients and staff, saying she is: “always prepared to challenge conventional wisdom to get the best results for those who receive healthcare services.”
This wide experience, her academic roots, and her conviction of the value of stories came together in Seeing the Person in the Patient, the report that set the path for the Point of Care Foundation. Quoting the medical historian Roy Porter’s observation that the modern hospital has been criticised “as a soulless, anonymous, wasteful and inefficient medical factory performing medicine as medicine demanded it, not as the patient needed it,” Jocelyn and her co-author Joanna Goodrich examined stories, surveys, and complaints to understand patient experience. They critically reviewed academic evidence on “patient-centred care,” and their search for evidence on what worked to improve patient experience led them to Schwartz Rounds and experience-based co-design, both of which are central to the work of the Point of Care Foundation. The report also identified the close link between staff wellbeing and patient experience, a recognition that is central to the work of the Foundation.
The 2013 report the Mid Staffordshire NHS Foundation Trust Public Inquiry, which described terrible experiences of patients, provided Jocelyn with the springboard to create the Point of Care Foundation with the dual aims of fostering a culture of putting the patient first and enhancing support for staff providing healthcare. She opted boldly for a business model that meant that the Foundation would need to sell its services into the NHS to succeed: customers in the NHS would need to be convinced of the value of what the Foundation could offer.
The first intervention offered by the Foundation was supporting the implementation of Schwartz Rounds, enabling staff from all disciplines to discuss difficult emotional and social issues arising from patient care in a confidential and supportive setting. Evaluation funded and published by the National Institute for Health Research has shown that participants think that the Rounds help them to provide patients with more compassionate care and feel less stress in their work. Regular attenders at the Rounds experience half the psychological distress of those who don’t attend regularly. The Rounds are now available every month to thousands of health and care staff, across more than 220 organisations.
The Foundation has established other evidence-based interventions to help humanise care, and Jocelyn has steered the Foundation to a position where it has staff who can continue the success of the organisation. It’s always a difficult moment for an organisation when its founder leaves, but Jocelyn saw that moment coming and ensured that the Foundation could flourish after her departure. As Jocelyn says in her article, there is still much work to do, and she would like to see the Foundation grow and have a still greater impact in humanising health and social care.
Sir Adrian Montague said: “I was privileged to serve as Jocelyn’s Chairman for the first five years of the Foundation’s life. The Foundation is her brain-child and she was its driving force. She rose magnificently to the challenge of a CEO’s responsibilities, handling both the establishment of the Foundation, the recruitment of a capable and committed board, whilst always continuing to press for the broadest possible application of the techniques developed in the Foundation to humanise healthcare. In all things, she wins friends, admirers and followers with her great warmth and charm.”
Jocelyn has not only developed the work of the Foundation but also come to be recognised as a leader in discussions on how patient experience can be improved. She was a member of the public inquiry into an outbreak of Clostridium difficile in Northern Health and Social Care Trust in Belfast, and she was instrumental in ensuring women’s voices were heard loud and clear in the 2017 Better Births national maternity review. She has always championed women in her work, as an advocate, role model, and mentor, and she featured in the Health Service Journal’s list of inspirational women in 2014. She continues to support doctors of the future: her niece, a medical student, says: “Jocelyn is definitely part of my inspiration to study medicine and has hugely shaped the kind of doctor I want to be. She inspires me to act with integrity every time I interact with patients, and to hold true to my values of humanising patient care. Jocelyn has supported me throughout my education and given me the confidence to stand up for myself and others.”
Finally, her personal presence and charisma has opened a great many doors and brought wide respect across health and social care. She is a leading champion of patients and staff who does her work with wisdom, grace, charm and humour. Above all she is one of those rare people who is able to translate the theory of humanising healthcare into practical reality. All who have worked with her at the Foundation feel privileged to have been able to help her in her life’s work.
Bev Fitzsimons, Richard Smith and Sir Robert Francis