Wednesday, 25 April 2007
Examining the Contribution of Reputation in the NHS
(and the House of Commons Health Committee Report - Patient and Public Involvement April 2007)
Source: House of Commons Health Committee Report - Patient and Public Involvement in the NHS April 2007
The people in the middle of the diagram are patients. Why do they have their hands up? Have they surrendered at last? And like the Japanese soldiers who emerged from the jungle years after VJ-Day, have they finally acknowledged that the battle to make the patient heard in the NHS is now lost?
2nd Lieutenant Hiroo Onoda
Perhaps they are hailing a new dawn where their opinions are at last held to be important and capable of influencing policies and processes? Or is it just that they are lost in the PPI maze and are waving to the helicopter to come and get them?
"A Plethora of Organisations"
The Health Committees report summed it up -
"There is much confusion. There is a lack of clarity about scope and purpose. Should patient and public involvement be about more accountability, better services or health promotion? A plethora of organisations are concerned with patient and public involvement and the number of organisations has been increasing."
Harry Cayton agreed with them about the lack of clarity. The Committee asks if whether this situation will be helped by the creation of yet another beastie - that of the LINKs - a new species of fauna to prowl the PPI jungle as described in a previous post (Greater LINks Spotted At Large and Unfenced).
We recommend the report to our readers http://www.publications.parliament.uk/pa/cm200607/cmselect/cmhealth/278/278i.pdf to pursue the detail as they wish.
Reputation Provides Purpose
What we want to discuss today is prompted by the discussion about purpose - "often confused and conflated". We offer as a key purpose the contribution to reputation - an issue that was not directly addressed in the committee's final report.
Yet if the NHS choice agenda develops as we are told it will and users do start thinking about where they should go to get their treatment, then reputation will become very important as users exercise those choices.
Reputational Risk Hazard
The National Consumer Council (NCC) wrote about this in their December 2006 report Regulation and Reputation making the point that "reputational risk" was seen by many US companies as their single biggest business hazard. Users use reputation - an indicator of past performance - as a predictor of likely future behaviour. Users pay most attention to the views of other people like them - the word of mouth mechanism. Only the most motivated or well-trained or Andrew Craig spend time looking at detailed performance tables and indices. But they understand and more importantly believe the stories. Lots of stories add up to reputation.
Parallel and Detached Universes
And have healthcare providers caught onto this? I have not gone through the entire list of 159 organisations or people who submitted written evidence but take a look at the shorter list of submissions printed in Volume III - of 19 submissions only 2 came from a healthcare provider - a Foundation Trust and a PCT. The patient voice and PPI and healthcare providers seem to operate in two parallel universes - uncommunicative and uncomprehending.
Customers for Patient & Public Involvement Outputs
Yet there is a potentially very productive relationship there. The providers of health and social care must be the customers for the views and information that PPI mechanisms can provide. What if those PPI networks became the creators and custodians of reputation - that their verdict on a provider's service was the one that was picked up and used by the NHS equivalents of the new 'switching' websites telling users where the best deals are? If you work as a health care provider, can you with confidence answer the questions
- What is the reputation of my service?
- What are the key drivers of this reputation?
- How do I know this?
Without good answers, a PCT or an acute Trust are clueless about what levers they can pull to restore reputation or ensure that they maintain a good one. Foundation Governors may be such a means but unless they are plugged into a bigger network, their voice may go unheard.
The new PPI structures have an opportunty to develop a role as independent creators and custodians of this reputational data. Health and social care providers will then have a compelling reason to engage with them. They will come to see it as a process that provides them with essential information and the means of understanding the way reputations are created.
Specific Situations Create General Reputations
We were reminded when we did a recent consultation asking questions about reactions to the new emphasis on primary care as the main deliverer to health close to home etc, that what gets people going is the specific and the personal. Broad strategies of urban redevelopment and renewal meant nothing unless and until it was their surgery that was going to be shifted and their doctors who were going to disappear into a mega-surgery where the personal relationships built over time would wither away. Then they stood up and spoke out. A "reputation-building" event has just been created. Like a typhoon springing from a tropical sea as warm air meets cold, the strategic and the day to day have just collided and the storm has the potential to wreck reputation.
Word of Mouth Damage
This was the lesson that US corporations learnt about reputation - legal actions about faulty or unsafe goods may cost a fortune in lawyers and fines, the real and lasting cost was loss of reputation and negative word of mouth (WoM) - remember what happened to Perrier? Take a look at what is happening now with Cadbury.
Reputation in the user's mind is the conglomeration of lots of individual experiences that all adds up to a reason to use or a reason to stay away. The care provider that is seen as falling in the 'stay away' category is left with the scraps of a market, reliant on the inert and ignorant whose contribution to reputation comes heavily discounted.
And if the 'reputational agenda' discussed by the NCC is taken up by health regulators, it will not be just potential patients who will be taking an interest. Will we be seeing reputation audits triggering both sanctions and rewards?
The Moore Adamson Craig Partnership is ready to help you with your Patient and Public Involvement initiatives, creating an energetic environment of trust and commitment amongst all involved. We can research and advise on reputation as well as offering training for representatives and those who work with them. We also support best practice in consultations - editing, analysing and facilitating public and patient involvement.
For further information call any partner and we will be happy to share our experience with you and discuss what you need.
Replies to Examining the Contribution of Reputation in the NHS
(and the House of Commons Health Committee Report - Patient and Public Involvement April 2007)
I've just been able to read the Spring update - thank you. As a member of two patient voluntary bodies and of course as a separate patient and a member of the public (just a little bit better informed than most) what the Health Department is doing with all these patient initiatives would drive me to drink or drugs, if I didn't already see something of the terrible consequences that does through my other voluntary activity at a local very large prison.
My enthusiasm to support such initiatives has drained away and though I feel an obligation to assist in the move to LINks, I have little confidence in the role and influence the new entity will have, especially as it is slowly also being starved of funding.
Local patient activist 2007-05-16 12:04:32
For anyone who doesn't think reputation matters, an instructive example is offered by the real ale consumers of the delightful Sussex town of Lewes. Faced with the high handed actions of Greene King in withdrawing the locally-brewed favourite tipple "Harveys Bitter", they boycotted the Lewes Arms, the town's most popular hostelry. Bar takings plummeted, but what wounded Greene King much more was the shed load of bad publicity, even extending to German television interviewing the indignant beer drinkers outside the boycotted public house. And it didn't do any harm to enlist the aid of The Guardian and the local MP - shrewd in Lewes they are.
In the end the company relented and retreated, reinstating the favourite brew. And it was concern for reputation that did the trick. As one of the protesters said "We've shown that it's possible for a small group of committed people to change the mind of a huge company. We knew the loss of trade was hardly going to make a dent in their huge profits, but the loss of reputation would really make them think, so that's what we had to aim for..." Would the local PCT or Foundation Trust be as responsive I wonder?
Andrew Craig 2007-04-25 20:45:27