Numbers are not enough

Here at MAC, we have a policy of making our blog space available to guest contributors who have interesting and useful stuff to say. Georgina Craig has created an approach she calls Experience Led Commissioning which puts patients and their experiences right at the heart of commissioning. If there is one message that our blog conveys, it is that things work better when you do this and this is a message that commissioners must hear. Georgina explains how she and colleagues do this using real people and their real stories. Read on.

Wot – No Commissioners?

This week, a group of 100 enthusiasts gathered in Oxford to contemplate the question ‘Do we know what patients want?’ Organised by the Health Experience Research Institute , expert speakers shared insights about the different methodologies for measuring and improving experience of care.

Whilst a lot of work has been done with secondary care providers on improvement methodologies and ways of collecting data, the absence of commissioners and primary care providers at the event mirrored the fact that there has been very little progress in the non acute sector – and indeed in commissioning.

“KFC” (Kings College and Kings Fund) are about to publish a report commissioned by he Department of Health to establish the current state of play in the NHS.

The Search for the Killer Question – the Holy Grail of NHS Metrics

Amongst other things, they have been searching for the Holy Grail – is there just one simple question we can ask that will measure experience across care settings? They looked at what people measure now. They found a vibrant industry in patient experience and a myriad of tools – resulting in thousands of different questions being asked across the NHS. The trouble is, this makes it almost impossible to compare organisations and benchmark. They also found that whilst secondary care at least collects a lot of data, there is less evidence that people are actually doing anything with it!

They conducted interviews across 5 conditions and found 6 common themes that encapsulate a good experience – so I am guessing we will see these in the commissioning outcomes framework:

  1. Feeling informed about my condition and available services
  2. Being involved in my care and decisions about my treatment
  3. Staff who listen and take time
  4. Valued support services
  5. Efficient processes
  6. Being treated as a person – not a number.

This is pretty intuitive. So, if it really is that simple, why is it that we seem unable to commission these easy-to-do things consistently?

The Nettle Ungrasped

I believe it is because we have yet to grasp the nettle and understand that before people change their behaviour, you have to capture their imagination and win their hearts and minds.

The fact commissioners have failed to do this is the reason why they have had so little impact on providers in the past. In fact, commissioners rarely seem to realise that system and change leadership is their job.

We want to help GPs to change that and have come up with an innovative new approach. We call it Experience Led Commissioning (ELC) and we are currently piloting it with Health Works – a GP pathfinder consortium in NHS Sandwell.

ELC is built around stories of care. It uses multimedia to hold a mirror up to the health economy. It articulates the commissioning and service improvement challenges in ways that engage managers and clinicians on a deep emotional level.

The Power of the ‘Evidence-Based Anecdote’

We use ‘evidence based anecdotes’ to illustrate and inform the process and provide commissioning insight. Through secondary analysis of the rigorous qualitative research archive behind the single story and its application in the same way others use marketing research, we turn real people’s stories into multimedia commissioning tools. Then we invite local service users and carers to sit down with commissioners to co-design a good service experience.

We have published our manifesto Putting patients at the centre of commissioning: experience led commissioning and we are recruiting GP commissioners to work with us.

Whilst it is early days, we are already finding that real stories help people connect with the purpose of commissioning in a way they have not previously. Luckily, having national data also means we have come up with a process that is replicable and potentially highly cost effective – important things in the current financial climate.

A great idea loves a void; and when it comes to creating a powerful commissioning approach that drives patient centred care, there is definitely a big one to fill. We are keen to work with everyone who shares our passion to make change happen. If that resonates, please get in touch.

We aim to improve health through people and specialise in working with commissioners to co design service improvement. Link with us on LinkedIn: georginacraig or email me at .


  1. Andrew Craig says

    Great piece Georgina! I think the killer question is the same for healthcare as it is for any other consumer experience: having had it, would you recommend someone else close to you (not your worst enemy!) to have it too? The power of recommendation and word of mouth has never been understood in the public services, much less harnessed for quality improvement purposes.

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