November’s Newsletter: No downturn here – M-A-C blogging team’s creative outputs breaks all records

10 posts since 30th September represents an all-time record as M-A-C engages with the issues and causes dear to our collective and individual hearts.

Our first ever post back in 2003 was about our central interest – user involvement. A theme echoed in this month’s output with Andrew’s post Engagement isn’t enough. Two posts later, we were taking a look at Ann Abraham’s approach to her then quite new job as Health Ombudsman. Complaints and the way they are managed and treated and what they mean for the organisations trying to deal with them are another abiding interest – see the piece on 24th looking at how common themes can emerge from different surveys of the complainant/ customer experience.

It is not all about the familiar themes – since 2003 we have broadened our interests to embrace two new areas – Policy Governance and parental involvement in schools. In the case of the model developed by John and Miriam Carver, Policy Governance® has taken a while to get off the ground in the UK. Most of the work and case histories reflected US practice and we have not had a good UK example of how this approach to corporate governance can help organisations here. Now the Southend University Hospital NHS Foundation Trust have led the way for others to follow. Val Moore reported on this on 27th October.

Finally, Caroline Millar reports on how the new models of participation – involvement, engagement – are impacting schools, parents and teachers. Her piece focuses on the consultation on complaint handling in schools and how parental problems are handled (or not).

We call ourselves a consultancy that specialises in the user interest. What keeps us interested and involved and in business, is how that interest can manifest itself in so many different contexts while the principles underlying best practice can be so similar. Different diagnoses, different solutions but underpinning them all are the common questions – what do users think of this? Has anyone asked them? Has anyone listened? Has anyone done anything with what they have heard? What happens when people have a problem? Easy really.

The final question that comes up when looking back over 5 years – has anything changed?  Well Andrew inspired us all with a 2006 look at what the NHS will be like by 2015. We are almost halfway there and what has come true? Well the Department of Health seems to see things the Andrew Craig way. Allowing people to pay for their drugs was something Andrew took a look at in March this year when he pointed out that ‘topping up’ was something that Beveridge seemed to have explicitly anticipated when he wrote about the State leaving “room and encouragement for voluntary action by each individual”.  As far as the management ethos of the NHS as a whole is concerned, we will wait and see how PG will change all that.

In the meantime, it is still worth repeating a little Olympic-flavoured M-A-C joke from 28th November 2006 -

A parable of NHS reforms

(Elements are borrowed from several sources and sexed up a bit by us)

An NHS rowing team raced against a Japanese team. There were eight people in each team, of similar fitness, but the Japanese team won by a mile. How could this have happened asked John Reid? Top NHS management established a committee of analysts, which reported that the Japanese had seven rowers and one captain, whereas the NHS has seven captains and one rower. The experts called for restructuring of the NHS team. The new team comprised four captains, two service managers, and a director who also did the rowing. After a second lost race to the Japanese, the single rower was dismissed on the grounds of incompetence, and the management team received a bonus for strong leadership. A new NHS boat is currently being designed , but is reported to be running behind delivery schedule due to IT problems.

Let us see what has changed by the Olympic year of 2012 assuming we have not had to make a choice before then between funding bread and circuses or the NHS.

Complaint Data – common themes confirmed in different surveys

It gets a little dispiriting if you work with complaints and complainants to see the same old messages emerge in survey after survey as the years go by. If I was a complainant, I would be tempted to be very rude to the next person who wanted me to complete a survey about the experience I had with my complaint. The questionnaires or the questioner have a little spiel along the lines of “your experiences will help us greatly in improving the way we handle complaints”. Really? There seems to be little sign of that.

The National Audit Office has taken a look at complaint handling in both health and social care services in anticipation of the creation of a single complaints system in 2009. Our friends at the Customer Care Alliance and Surveylab have just published their annual look at the complainant experience across a variety of markets and providers based on a survey done during July, August and September 2008. 10,102 responses were received from a random sample of UK consumers and some 230 of them had their most serious problem with health care services.

The findings from the two surveys cannot be compared directly but some interesting common themes emerged – the same reason came top in the list of reasons why many did not bother to complain. Namely, the perception was that nothing would change as a result of voicing that complaint. The NAO survey which focussed exclusively on health and social care services asked more detailed questions about both the informal and formal processes. Young people were especially likely to drop the matter at the mention of a formal process. The people who persisted – this came through with the health care problems – were those who were looking after or complaining on behalf of someone else and there is an interesting suggestion with the social care data that readiness to voice dissatisfaction was linked to whether or not part at least of the service had been paid for. Class and age played their usual part in readiness to voice with ABC1s and 35-54 year olds the more likely to take the problem up.

Social care service problems are most often triggered by a social worker or home help and this personal flavour to the problem explains why people with a problem with for example the bad standard of treatment, worried about the effect of making a complaint, not wanting to damage a continuing relationship with the service provider.

What did complainants want? The CCA survey asked directly whether revenge would be nice. 7% of men said yes to that compared to only 1% of women. That same survey confirmed that what people wanted overwhelmingly was an apology (46%), an explanation (57%), and an assurance that the problem would not be repeated (40%). One of the most telling pieces of data in this study (the NAO did not ask the question) was that 54% of the people who were dissatisfied, shared that experience with friends/ colleagues.

Ministers despair that people do not believe what they are told about the health service. As we have said before, we listen to and more importantly believe our friends more when it comes to service experience. Service reputation lags well behind the public announcements – the speeches, the ads – because private user information (the wisdom of the crowd) discounts these official messages in favour of their word of mouth sources.

We will await the lessons from the early adopters programme for the new combined health and social care complaint handling arrangements and how well local providers put in place their own arrangements within the Making Experiences Count framework. The main pitfall to avoid when building new organisations is to push complaint handling to the back of the process building queue. This overlooks the fact that good complaint handling is an vital resource for users who have been dissatisfied by some aspect of the fledgling organisation’s service delivery. Bad first impression plus bad problem resolution equals poor reputation straight after launch – revisit our thoughts on who gets believed.

In the meantime,  service process designers and commissioners need to look out for the user who is ABC1, 35-54 years old, responsible for someone else’s care. Lives in London and the South East and has lots of friends. Your reputation rests in their hands. Sort them out quickly with an apology and an explanation and just as most of those users do not want revenge, avoid giving any impression that vulnerable users still in the system will suffer for being cheeky and complaining. Worth perhaps repeating that stunning bit of data from the UK Customer Care study showing the rewards of good complaint handling that satisfies your users.