Mark Britnell: What industry teaches the NHS about self-management

Over the last two decades many industries have radically changed the way they operate by developing their customers’ capacity to create value.

Healthcare is only just understanding how placing patients at the centre of their own care could dramatically transform delivery models.

Customer driven change has transformed various industries, not just at the customer interface but from the inside out.

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Inside out innovation

In supermarkets, shoppers initially became used to doing all the work of selection themselves and, later on, even at the checkout. Now customers order their goods online and have them delivered without ever stepping foot inside a store.

In banking and telecoms, customers expect seamless integration of different services and a single point of contact for managing them.

These changes have not been achieved by retailers retreating from delivering services to their customers.

‘Retailers have simply changed their role in the decision making and buying process in relation to their customers’

They have simply changed their role in the decision making and buying process in relation to their customers.

Retailers developed a powerful set of logistic tools that sit behind and around the shopper’s own work, and ensure a much wider range of products are available. In order to invest in shoppers’ capacity to carry out this extra work, retailers have developed far more flexible, immediate supply chain management.

Similarly, for this to work in healthcare there will have to be much better logistical support around patients self-managing their own care.

Patient driven outcomes

If we are honest, one of the reasons that healthcare has missed out on the opportunity of empowered patients playing a bigger role in their own care has been that we have seen patient involvement as an ideological and not an economic issue.

However, the economic pressures on the NHS and other systems have finally reached a point where the financial debate is focusing on the potential impact of more fully involving patients in their own healthcare. We must find new ways to create health outcomes through patients themselves.

It is this need that is behind the study by KPMG’s Global Healthcare Centre of Excellence called Creating new value with patients, carers and communities - launched today at a conference co-hosted by KMPG and the Reform think tank. In this study we looked into the ways innovative health systems around the world create higher value healthcare by practically involving people more fully in their own care.

‘The alignment between what patients want and what is provided is poor’

Healthcare leaders know that in many cases the alignment between what patients want and what is provided is poor.

Indeed, 89 per cent of the healthcare leaders from 30 countries - who attended our global healthcare conference this month - admitted that healthcare delivery is currently “structured more according to organisational structures and boundaries than the needs of the patient”.

They understand that in many cases the benefits of shared decision making and patient and carer involvement are not being realised.

Our study goes beyond simply championing the ideology of patient driven care and describes a nine part framework for realising the value that can be achieved through the role of patients, carers and communities.

It demonstrates that a significant change in our offer to patients and citizens will occur when the industry recognises the efficacy of extending its work from healthcare to health and well being.

Delaying the onset of long term conditions into older age will need very different interventions from traditional healthcare but will considerably increase the value delivered by the system.

Activate patients

Alongside our new study, we established an online “crowd sourcing” community. What we heard in this debate reinforced the view that, for too many organisations, patient experience is still more of “nice to have” than “mission critical”.

While the vast majority felt patient experience now has a big impact on their organisation, less than half of organisations include patient experience measures in clinicians’ or managers’ performance appraisals.

We also conducted detailed studies in six countries across Europe, Asia and the Americas, asking patient organisations - representing tens of millions of individuals - about the gaps between what patients want and the services they receive. The results will not surprise those who have read the work of England’s Richmond Group but they provide a radical critique of the way services are organised.

This critique must start with the recognition that, for most patients with long term conditions, self-care is not something that a health service introduces; most of their care already is self-management.

‘Organisations need to ensure every interaction with patients increases their capacity to be active in their own care’

NHS England chief executive Simon Stevens recently outlined how he hoped clinical commissioning groups would use patient activation measures.

The point of measuring patient activation is not to passively measure where patients are and leave them there. The point is that healthcare organisations need to ensure every interaction they have with their patients increases their capacity to be active in their own care.

Our report explores the different ways this can practically be achieved, from involving patients in service design to providing them with better relevant information, and investing in the assets in the families and communities around them.

The benefit of this is by no means marginal. Independent analysis suggests that the most activated patients cost between 8 per cent and 21 per cent less. As the Wanless report reminded us over a decade ago, an engaged and activated patient is the only way to ensure a sustainable NHS.

Finally, while patient activation is becoming “über fashionable”, I’m not so sure it is an attractive phrase for patients, so we probably need to collectively think of a more attractive offer.

We should ask patients themselves.

Mark Britnell is chair and partner of the global health practice at KPMG