Add to your vocabulary with the rhyming phrase l’arrière-goût de déjà vu – the after-taste of d v. This was my rather acid mood when contemplating what to say about the latest report from the Ombudsman on complaint handling in the NHS.
Anything New to Say?
Could there be anything new to say that would put a positive reading on what was in danger of being dismissed as a ‘same old, same old’ commentary. Repeated Ombudsman reports have told us over and over that the NHS continues to have great difficulty in getting complaint handling right. After all a rise in complaints of 50% in a year looks pretty bad. A crude count though is not everything and this may not be as bad as it looks if three other things were true – high satisfaction with the way the complaint was handled, evidence that systemic quality failures were fixed following complaints and that the sums of money being paid out to people who sued the service were steady or going down. An estimated £15.7 billion was earmarked in the Whole Government Accounts for NHS compensation costs and it could be higher – over £20b. The trend is up with a 30% rise in claims logged.
Anthing New to Do?
There are no data available on the first two questions and the third is heading in the wrong direction. So more may well mean worse.So what is anyone doing about this and how will this activity be taken on board by the new NHS commissioners? The Ombudsman tells us:
As the new NHS arrangements are implemented, we will provide information about patients’ experiences to the new NHS commissioners – both to the local clinical commissioning groups that directly buy services from the NHS and independent providers, and to the national NHS Commissioning Board that will commission primary and specialist care. We will do this to help inform their commissioning role. We will also work with the NHS Commissioning Board to assist in embedding good complaint handling across the NHS.
Conversations we have had recently with some of the new CCGs (Clinical Commissioning Groups) are telling us that the new bodies are trying to make a fresh start in the broad area of patient engagement. They fear the reaction of an uninvolved and uninformed public to the big changes to the service in the future and the understanding is growing amongst them that they need to see lots of information from users and carers from all sorts of sources. One key source of service provision intelligence is the complaint figures from the organisations providing the services commissioned.
Real World and the Recommend Question
Hearing from the Ombudsman – the very tip of the escalated iceberg – is not enough. Yet if these are the only data publicly available, those are the only data that Commissioners will have to hand come contract time and a provider may find itself being judged on one or two complaints – the ones that have got through to the Ombudsman. They must therefore in their own defence provide more data from the frontline – contacts, concerns, problems aired and problems solved, satisfaction data from service users whether or not they have complained or not – to put the escalated complaint in a real world operational perspective.
So once again the call is – More data please! to include complainant satisfaction data and evidence of action using these data. The NHS Mandate majors on the Friends and Family test – the ‘recommend to friends and family’ question. Not everyone likes this. There is a debate between the measurement maestros who go for the golden measure – the single key over-arching metric like this one – and those who shy away from relying on the over-simplified overview based on a single measure. We tend to take the ‘just do it’ line – once people get into the satisfaction measurement habit, the way they do it and the way they use it, generally get better and better over time at doing this in the way that gets them the data they can use most effectively.
The Universe of WoM
One extra tip by the way – ask your respondents how many people they have talked to about their recent experience. Factor this WoM (Word of Mouth) data taking bearing in mind social network activity into the more or less ready to recommend answers and you start to get an idea of what the universe is saying about you. After all if a sample of 50 people who will not recommend, badmouth you to say 20 people, they will reach collectively 1000 people – a few Tweets and reTweets plus a paragraph in the local freesheet circulation 20,000 households – readership 40,000 – you can see how it builds and how reputations are made and unmade. Final sad fact – badmouthers are eager to share their woes and talk to far more people than the contented.
A Blast from the Past – a Historical Note on One’s Own Trumpet
An aside from the vaults of history – as far as I know the first discussion of the recommend question and how valuable that was for companies was in a short book called Consumers in Business which I wrote for the National Consumer Council in the early 80’s – I would tell you the date of publication exactly but I have lost my copy. I do not claim to have invented it – that honour might well go to my then colleagues at TARP Inc the first US complaint handling and satisfaction measurement consultancy – but it is interesting to see how long something like this can take to filter into the consciousness of huge monolithic enterprises – almost 30 years. Is the NHS really that slow to change?
Honey can begin to flow from the jawbone of this particular ass (complaint handling) transforming the bitter gall of bad news complaints into something delicious to spread on the NHS bread. Then the National Commissioning Board will adopt the following verse as its anthem:
Isn’t it funny
How a bear likes honey?
Buzz! Buzz! Buzz!
I wonder why he does?
(Winnie the Pooh – Climbing Thoughts )
It does because the data honey tells you stuff.