Learn from business to improve patient experience

The experience of engaging the views and perspectives of people who use mental health services in the commissioning of those services has formed the basis of this article.

Its content is not designed to be prescriptive but to generate ideas about how services are really experienced and invite conversation about how services could be commissioned in the future.

The ideas and concepts being posed are not new initiatives but attention is being drawn to the notion that someone who experiences a service should become a more prevalent consideration in the commissioning of those services.

During a session with an audience of Bachelor’s and Master’s social work students the following questions were asked:

• How differently would you work with a client if they, rather than your boss, decided whether to pay you at the end of the session or not? The question was met with silence.
• What would you do if they were unhappy with a GP appointment? “Avoid going to the GP” was the most popular response.
• What would you do if you were unhappy with a hotel you had booked on your holiday? “Demand a refund”, ”complain”, “ask to switch hotels” and “demand to be upgraded” were the answers.

Where’s the customer service?

People understood that the difference between the two scenarios was the physical act of actually “paying” for a service.

There are many people who have to use health and social care services. Within mental health specifically there is a general belief that if complaints are made a service will be refused in the future.

People have given accounts of GPs threatening patients with being struck off the practice list if they complain and of mental health professionals writing someone off as a difficult patient when they expressed dissatisfaction with the service.

The threat of removing services to get people to comply leaves commissioners with the headache of commissioning “specialist” services to deal with people who have been excluded from all other services. Is this really efficient?

‘Our public services need to adopt the business model of engagement’

How is it that we do not adopt the same level of focus on customer service within our health and social care services that we do in our consumer services?

Would Microsoft or Apple tell a complaining customer that if they carry on complaining their computer will be removed?

The business sector relies on the customer to sustain their business. So in order for the business sector to survive they must ensure the customer gets a good service. Businesses have targets, cost cutting, staffing issues, just as health and social care services do and yet they are able to focus on ensuring good customer service as well.

Surely our public services need to be adopting the business model of engagement, particularly in light of commissioning the concept of personal budgets, payment by results and the pressures of efficiency savings.

Is it true that we still operate in a culture where the service user or patient has no control or choice over their healthcare despite the endless conversations, meetings and mission statements that claim that they do?

To access or not to access

In reality some people feel that their choices lie in the decision to either access the service or not access the service. Opinions often are: “You can only come to this service if you satisfy x,y and z” and “if you don’t attend your appointments at these times we will discharge you”.

Hearing service provider responses like “you can’t have that because our contract says so” or “we cannot see you at home because we don’t do outreach” would suggest that choices are incredibly limited.

It is understandable that parameters are needed to make services tenable and generally people who use services can understand this but basic customer service principles are absent.

Examples include not being honest about waiting times, not consulting people about service changes for fear of upsetting people and the endless reports of rude receptionists and professionals. None of which are behaviours that one would expect for a service being physically paid for.

‘The infrastructure of our services is not equipped to deal with actually implementing personalistiong as a concept beyond personal budgets’

Is it so culturally ingrained within our society that as a patient/service user, you have no power, despite the introduction of personalisation?

It is clearly evident that the infrastructure of our services is not equipped to deal with actually implementing personalisation as a concept beyond personal budgets. Trying to deliver new concepts within old fashioned structures is likely to be fruitless.

How as commissioners can you make sure that the people you are serving are generally happy with the service they receive? How can choice and control really and truly be embedded and evidenced in the services you commission? Does the business sector have the answers?

Is the reason for the difference between consumer companies and public services about who is viewed as the customer?

If the commissioner controls the money within health and social care it surely makes sense for the provider to focus on keeping the commissioner happy. Where does this leave the person receiving the service? Experiencing the antithesis of personalisation?

Adele McCormack is engagement manager at the Service User Network. SUN is designed to ensure user involvement in the commissioning of mental health services in Cambridgeshire