‘Patient Care:
Getting beyond the Rhetoric’
Tom Frawley, NI Ombudsman
NIPEC Conference
Armagh City Hotel
22 October 2014
NIPEC Annual Conference
Professional Standards Enhancing Person-Centred Care
"A patient is the most important visitor on our
premises. He is not dependent on us. We are
dependent on him. He is not an interruption to our
work. He is the purpose of it. He is not an outsider to
our business. He is part of it. We are not doing him a
favour by serving him. He is doing us a favour by
giving us an opportunity to do so.“
Mahatma Ghandi
The general feeling...
“When one is in office, one has no idea how
damnable things can feel to the ordinary rank
and file of the public.”
Sir Winston Churchill
What the public expect
• Accessibility – GPs, out of hours, A&E;
• Responsiveness – early advice, being seen;
• Effectiveness and safety – right treatment in
right timeline, safe and appropriate;
• Openness – patient as partner; and
• Transparency – accessible records, audits,
peer reviews.
A word of advice...
“Follow the customer, if they change...we
change.”
Sir Terry Leahy
Former Chief Executive, Tesco plc
Spoken at a time when Tesco were taking £7
out of every £10 spent in UK retail.
Breast cancer awareness in the 90s.
What the patient expects
• Accessibility – timeliness as well as distance – retrieval
systems/motorways;
• Knowledge – generalist and specialist;
• Skill – holistic approach;
• Care – compassionate and humane;
• Effectiveness of clinical interventions;
• Empathy for my circumstance, my humanity;
• Respect for my autonomy as a person - compassion;
• Dignity; and
• Leadership – where is leadership? Clinical, organisational, corporate, front
line critical.
The imperative
To deliver a genuinely patient-centred health
service.
Critical transitions
• Transition from professional management to
organisational management;
• Transition from operational management to
strategic management;
• Transition to an improvement focus through
doing more with the same resources;
Transition to a more user sensitive
service means:
• Patients who accept responsibility for their
well being;
• Public who accept health resources finite;
• Every patient should receive a statement
detailing what their care costs;
• Every member of staff aware of costs and
opportunity costs.
Patient care – why do we need to get beyond
the rhetoric?
Public confidence is being undermined – trust is
key.
Why? Because...
Public trust is being lost as a result of:
• Tolerance of poor practice;
• Secrecy about professional’s performance;
• Poor communication;
• Paternalism;
• Inadequate accountability; and
• Regulation not sufficiently open and transparent.
GREATEST PROTECTION FOR NHS IS PUBLIC SUPPORT
Why? Because...
The past - relatively simple, to give and get. Professionals gave
time and training and expertise and expected in return to get
deference, respect and job security. Medicine simple and
relatively ineffective.
Now – increasingly complex. Much greater accountability,
more assertive and better informed patients, a need to
collaborate with other professionals, constant evaluations,
inspections, audit, and soon, regular reviews of competence
to practice. Medicine extremely complex, dangerous and
much more effective.
Essential that nurses:
• Regain and maintain trust;
• Be polite and considerate even when others
rude;
• Respect patient’s privacy and dignity;
• Respect right of patients to take part in
teaching and research;
• Respect right of patients to second opinion.
Good communication is central
• Listen to patients and accept their view;
• Give patients access to information they ask
for about their condition in a way they
understand;
• Share information with families, having first
secured patient’s consent.
Challenges for nursing as a
profession
• Focus;
• Maintain a balance between generalism and
specialism;
• Build a workforce;
• Manage resources, prioritise;
• Build patients and public trust and confidence;
• Public engagement by leadership;
• Manage expectations.
Challenges for leadership, including
NIPEC
•
•
•
•
•
•
•
Live and breathe clear vision, values/standards;
Demonstrate leadership for whole profession;
Build patient engagement;
Communicate – internally/externally;
Focus on front line;
Do not assume goodwill - nurture it;
Care for each other.
Why? Because...
•
•
•
•
•
•
Change in public expectations;
Accessibility and choice;
Responsiveness;
Effectiveness and safety;
Openness;
Transparency.
Increasingly comparing public sector with private
sector.
So...why do we want to get beyond
the rhetoric?
• Because society’s expectations are changing;
• Because government’s approach is changing;
• Because our public sector values should
demand it of us;
• Because we are obliged to be accountable.
The core reason is:
Because it is the right thing to do.
How? By...
Developing an overpowering sense of the patient
experience:
•
•
•
•
•
Invest in listening systems and training;
Testing the user’s experience regularly;
Taking complaints seriously;
Hardwire the patient’s experience;
Establish ‘concierge’ strategy.
How? By...
Developing a listening strategy
• Continuous measurement of user satisfaction;
• ‘Smoke detector’s v ‘fire alarm’ system;
• Mystery shoppers in retail sector an exemplar;
• Discover what is important to the patient – values
critical - courtesy, care, compassion, competence,
courage, commitment and communication – 7 Cs.
How? By...
Responding effectively to complaints.
Characteristics of excellent service (by frequency of
mention):
• 13% ‘they go the extra mile’.
• 14% ‘they make it personal’.
• 25% ‘they deliver the promise’.
• 48% ‘they deal with complaints and queries
brilliantly’. (John Lewis research)
Statistics derived from research by Customer Institute
How? By...
Seeing patients as central.
Complaints are not problems, they are opportunities to:
• Identify problem areas;
• Interface with users;
• Provide service and satisfaction to dissatisfied clients;
• A second chance to resolve problems – GET IT RIGHT.
‘Complaints are opportunities to rebuild TRUST’.
‘Opportunity is missed by most people because it is dressed in
overalls and looks like work’.
How? By...
Doing something about what we hear.
• ‘Dialogue with users is only real if something
happens’.
Katrina Sporle
• Disney’s ‘touch points’.
• Exercising your professional duty of candour and give
a constructive and honest answer to anyone who
complains.
But, the bigger question remains...
How do we go beyond the rhetoric of change
and achieve improvements that are genuine,
lasting, transformational?
How? By...
Changing the culture:
• The most significant shift should not be
structural but cultural;
• A renewed focus on the patient requires a
renewed focus on our staff creating capacity
for dealing with changing expectations of
customer service and managing expectations.
How? By...
Changing the culture:
• The most significant shift should not be
structural but cultural;
• A renewed focus on the patient requires a
renewed focus on our staff creating capacity
for dealing with changing expectations of
customer service and managing expectations.
How? By...
Changing the culture:
• What makes our staff tick, motivates them,
gets them out of bed in the morning?
• The big question is who do they work for...the
public or the public sector?
• It’s a question of values.
• Need to align individual values with
organisational values.
How? By...
‘Living out’ Public Service Values in health
1.
2.
3.
4.
5.
6.
7.
Selflessness
Integrity
Objectivity
Accountability
Openness
Honesty
Leadership
Public servants ‘have a
duty to uphold the law
and to act on all
occasions in accordance
with public trust placed
in them’.
“Speech is conveniently located midway
between thought and action, where it often
substitutes for both”.
John Andrew Holmes
How do we get beyond the rhetoric of customer
care? By remembering:
“Things do not change, we change”.
Henry David Thoreau