UK view: Listen to patients and staff


The NHS and local authorities are setting the future direction of health and care in new Sustainability and Transformation Plans. Listening to staff and patients should be at the core of drawing up those plans, says John Morley, CEO of Formic

John Morley, CEO of Formic

The most successful organisations in the world aim to deliver high quality services that are built around the needs of the customer, informed by the voice of frontline staff. So why not do the same for health? 

It is common sense. Ask patients for their views on the care they receive, and use this feedback to inform care delivery and identify areas for service improvement. This was for example, a key recommendation from a recent report in the UK by The King’s Fund on maternity services.

We also need to listen to staff views in order to deliver the best health and care, and the link between patient and staff experience and the quality of care was recognised by NHS Employers in 2014.

As NHS England's director for patient experience, Neil Churchill, points out, patients who have a better experience of care generally have better health outcomes. At the same time, poor experiences generally lead to higher costs, since patients may have poorer outcomes, requiring longer hospital stays or needing to be re-admitted for further treatment.

The independent regulator of all health and social care services in England, the Care Quality Commission, recognises the need to listen to staff and patients to inform quality and service improvement. Its inspectors use data from the Friends and Family Test, a staff and patient experience survey, and other sources of individual feedback, when delivering their verdict on the quality of care.

Nine out of ten people would recommend the NHS to others

Listening to patient feedback is disconcerting for some. People may fear that mistakes will be picked up, or negative feedback will dampen staff morale.

Yet, in the Friends and Family Test, nine out of ten people give positive feedback. Most people think that the care they receive from the NHS is amazing.

Of course there are always problems and shortcomings. However, the NHS has access to an enviable depth of customer insight to identify these areas and address them. Many companies would be envious of how many of its customers share a vast amount of positive feedback about the service as a whole, as well as providing helpful views on quality and service improvement.   

Listening is good, and this listening function now needs to spread more widely, as a move to integrate health and social care takes shape. As Neil Churchill has noted, listening to patients’ experiences must stretch across health and care pathways. And the patient experience should be considered right at the start of the journey towards integrated care.

The views of frontline staff are equally important. They witness the good, the bad and the ugly on a daily basis. They see what should be improved, and most often will know what needs to happen to realise improvements.

Staff and patient views need to inform future care plans

It is essential the NHS recognises patient and staff views are central to the design and delivery of care. It is what the new models of care will be judged against, not only by inspectors, but the million-plus staff working in the NHS, and also the public at large.

So it is disconcerting that staff and patient experience are not given as much prominence in the Sustainability and Transformation Plans (STPs). STPs represent a shift in the way the NHS in England plans its services, with NHS organisations being told to collaborate in developing more integrated models of care. This will involve the health and social care systems working together to provide more co-ordinated, patient-centred services.

However, patient experience is mentioned only three times in the STP guidance; staff experience is not mentioned at all. Add to this a tight timescale to draw up the plans, and further problems emerge.

As The King’s Fund has noted from interviews with those involved in STPs, there has not been enough time to adequately involve clinicians and frontline staff. Patients and the public have been ‘largely absent’ from the process.

The changes proposed by STPs will come out for consultation; that is the law. It is unfortunate, however, that the plans do not make more of the views of patients and staff in designing how care will look for a generation to come.

Technology can help deliver patient and staff insight

It does not take long to gather patient and staff views. There are technology platforms that enable paper and digital surveys to be distributed at scale and at pace, with results available in near real-time and presented in meaningful ways. Actionable customer insight is close at hand.

Advances in big data and predictive analytics mean that huge datasets can be analysed for sentiment and preference in moments. Understanding and acting on insights from positive and negative customer experience underpins some of the world’s most successful businesses. Healthcare can, and must, do the same.

The NHS delivers some of the best care in the world, and staff and patients consistently provide excellent feedback based on their experience. But they can also tell when things can be improved.

The STPs are not perfect, as many policy makers admit. However, we should work with them as they will provide the framework for health and care services in years to come.

It is important to ensure the voices of patients and staff are at the centre of these plans, or we risk designing a future in which no-one has a stake.

John Morley is CEO of Formic Solutions, a company specialising in health and care surveys used for patient and staff experience research and analysis, and clinical audit.

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