It was my personal experience as a Non Executive Director of a large London teaching hospital well on its way to being a Foundation Trust, that a huge amount of really worthwhile liaison and consultation went on directly with patients, their families and carers at a ward, clinic or department level and that this information did influence the way that specific areas operated or a particular service was delivered. Patients worked alongside clinicians and nurses to solve complex problems about treatment, side effects, after care, etc. The successful results of these projects were proudly presented to the hospital staff and managers and the public at large events such as the AGM and open days. Senior managers up to and including Board level Directors expressed surprised admiration for the individual projects presented. They praised the forward thinking of the staff involved and thanked patients and their family and carers for their co-operation and contribution.
However I saw little evidence that anyone recognised the wider value of all these ad hoc “pearls” of patient involvement. Senior managers seemed reluctant to use patient feedback unless it came via a formal survey and yet the people willing and able to answer a survey may not be current patients with direct experience. They missed the potential greater significance of this collection of direct personal patient and carer experience which had been collected whilst patients were actually on the wards and in the clinics. They underestimated the value of views from long term patients who came back to the hospital time and again and they failed to see that the outcomes of an ad hoc project could be relevant to other patients and applicable to other wards, clinics or procedures within the hospital. Even where the outcomes were startling and led to significant changes in long standing treatments and procedures on the specific ward in question, the “executive mind” missed the possible connection to other areas of the hospital.
I have not now been a Non Executive Director for several years and perhaps things have changed but I fear that some hospital trusts are still not seeing the wood for the trees – they still don’t see the patient experience in the round – they are obsessed with high level measures and satisfying external regulators. I feel hospital trusts still think in narrow terms about the patient contribution and do not look for the wider application. This sort of attitude undervalues the time of staff and patients and is wasteful of the resources committed to the specific project. It also leaves the hospital open to criticism about a lack of wider patient and public involvement when in reality it is making a good start.
The GP patient experience….
In my experience there can be a similar narrow interpretation of patient involvement at GP surgeries. Many tend to rely on sending out formal surveys and questionnaires and don’t see that every patient who walks through the surgery door has a view worth hearing. Where GP surgeries do think beyond surveys and form filling, they tend to think the only way forward is to set up one of those “awful patient groups” that is bound to take up time and resources and only attract people who want to grumble about the electronic notice board in the waiting room or the lack of parking spaces.
Whilst patients Groups can be really effective – and I speak as a member of one of the longest standing most effective Patient Groups in London – they are not the only way to engage patients and collect their views and ideas. GP surgeries have direct and easy access to patients, many of whom return regularly to the surgery. They could be a source of valuable information if asked brief, timely and relevant questions when they are on the premises. Patients generally don’t want to answer a 10 page questionnaire but they would answer 2 or 3 questions about the experience they have just had with the GP, nurse or administrative staff. They would probably take the time to comment on whether their health worries been addressed if they were asked in the right way and they might even say what they really think about the medical treatment they are getting if they believed someone was taking notice of what they said.
The whole is greater than the sum of the parts
Each individual patient input can teach us something and it is vital that we do not lose these valuable patient and user experience “pearls” that are available freely every day to hospitals and GP surgeries. But taken together they are even more valuable, giving us a wealth of understanding and learning through which we can improve the care and treatment provided right across the NHS.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations.