‘Patient Care: Getting beyond the Rhetoric’Tom Frawley, NI Ombudsman

NIPEC ConferenceArmagh City Hotel22 October 2014

NIPEC Annual ConferenceProfessional Standards Enhancing Person-Centred Care

"A patient is the most important visitor on our premises. He is not dependent on us. We are dependent on him. He is not an interruption to our work. He is the purpose of it. He is not an outsider to our business. He is part of it. We are not doing him a favour by serving him. He is doing us a favour by giving us an opportunity to do so.“

Mahatma Ghandi

The general feeling...

“When one is in office, one has no idea how damnable things can feel to the ordinary rank and file of the public.”

Sir Winston Churchill

What the public expect

• Accessibility – GPs, out of hours, A&E;• Responsiveness – early advice, being seen;• Effectiveness and safety – right treatment in

right timeline, safe and appropriate;• Openness – patient as partner; and• Transparency – accessible records, audits,

peer reviews.

A word of advice...

“Follow the customer, if they change...we change.”

Sir Terry LeahyFormer Chief Executive, Tesco plc

Spoken at a time when Tesco were taking £7 out of every £10 spent in UK retail.

Breast cancer awareness in the 90s.

What the patient expects• Accessibility – timeliness as well as distance – retrieval

systems/motorways;• Knowledge – generalist and specialist;• Skill – holistic approach;• Care – compassionate and humane;• Effectiveness of clinical interventions;• Empathy for my circumstance, my humanity;• Respect for my autonomy as a person - compassion;• Dignity; and• Leadership – where is leadership? Clinical, organisational, corporate, front

line critical.

The imperative

To deliver a genuinely patient-centred health service.

Critical transitions

• Transition from professional management to organisational management;

• Transition from operational management to strategic management;

• Transition to an improvement focus through doing more with the same resources;

Transition to a more user sensitive service means:

• Patients who accept responsibility for their well being;

• Public who accept health resources finite;• Every patient should receive a statement

detailing what their care costs;• Every member of staff aware of costs and

opportunity costs.

Patient care – why do we need to get beyond the rhetoric?

Public confidence is being undermined – trust is key.

Why? Because...

Public trust is being lost as a result of:• Tolerance of poor practice;• Secrecy about professional’s performance;• Poor communication;• Paternalism;• Inadequate accountability; and• Regulation not sufficiently open and transparent.

GREATEST PROTECTION FOR NHS IS PUBLIC SUPPORT

Why? Because...

The past - relatively simple, to give and get. Professionals gave time and training and expertise and expected in return to get deference, respect and job security. Medicine simple and relatively ineffective.

Now – increasingly complex. Much greater accountability, more assertive and better informed patients, a need to collaborate with other professionals, constant evaluations, inspections, audit, and soon, regular reviews of competence to practice. Medicine extremely complex, dangerous and much more effective.

Essential that nurses:

• Regain and maintain trust;• Be polite and considerate even when others

rude;• Respect patient’s privacy and dignity;• Respect right of patients to take part in

teaching and research;• Respect right of patients to second opinion.

Good communication is central

• Listen to patients and accept their view;• Give patients access to information they ask

for about their condition in a way they understand;

• Share information with families, having first secured patient’s consent.

Challenges for nursing as a profession

• Focus;• Maintain a balance between generalism and

specialism;• Build a workforce;• Manage resources, prioritise;• Build patients and public trust and confidence;• Public engagement by leadership;• Manage expectations.

Challenges for leadership, including NIPEC

• Live and breathe clear vision, values/standards;• Demonstrate leadership for whole profession;• Build patient engagement;• Communicate – internally/externally;• Focus on front line;• Do not assume goodwill - nurture it;• Care for each other.

Why? Because...

• Change in public expectations;• Accessibility and choice;• Responsiveness;• Effectiveness and safety;• Openness;• Transparency.

Increasingly comparing public sector with private sector.

So...why do we want to get beyond the rhetoric?

• Because society’s expectations are changing;• Because government’s approach is changing;• Because our public sector values should

demand it of us;• Because we are obliged to be accountable.

The core reason is:

Because it is the right thing to do.

How? By...

Developing an overpowering sense of the patient experience:

• Invest in listening systems and training;• Testing the user’s experience regularly;• Taking complaints seriously;• Hardwire the patient’s experience;• Establish ‘concierge’ strategy.

How? By...

Developing a listening strategy• Continuous measurement of user satisfaction;• ‘Smoke detector’s v ‘fire alarm’ system;• Mystery shoppers in retail sector an exemplar;• Discover what is important to the patient – values

critical - courtesy, care, compassion, competence, courage, commitment and communication – 7 Cs.

How? By...

Responding effectively to complaints. Characteristics of excellent service (by frequency of

mention):• 13% ‘they go the extra mile’.• 14% ‘they make it personal’.• 25% ‘they deliver the promise’.• 48% ‘they deal with complaints and queries

brilliantly’. (John Lewis research)Statistics derived from research by Customer Institute

How? By...

Seeing patients as central. Complaints are not problems, they are opportunities to:• Identify problem areas;• Interface with users;• Provide service and satisfaction to dissatisfied clients;• A second chance to resolve problems – GET IT RIGHT.

‘Complaints are opportunities to rebuild TRUST’.‘Opportunity is missed by most people because it is dressed in

overalls and looks like work’.

How? By...

Doing something about what we hear.• ‘Dialogue with users is only real if something

happens’. Katrina Sporle

• Disney’s ‘touch points’.• Exercising your professional duty of candour and give

a constructive and honest answer to anyone who complains.

But, the bigger question remains...

How do we go beyond the rhetoric of change and achieve improvements that are genuine, lasting, transformational?

How? By...

Changing the culture:• The most significant shift should not be

structural but cultural;• A renewed focus on the patient requires a

renewed focus on our staff creating capacity for dealing with changing expectations of customer service and managing expectations.

How? By...

Changing the culture:• The most significant shift should not be

structural but cultural;• A renewed focus on the patient requires a

renewed focus on our staff creating capacity for dealing with changing expectations of customer service and managing expectations.

How? By...

Changing the culture:• What makes our staff tick, motivates them,

gets them out of bed in the morning?• The big question is who do they work for...the

public or the public sector?• It’s a question of values.• Need to align individual values with

organisational values.

How? By... ‘Living out’ Public Service Values in health

1. Selflessness2. Integrity3. Objectivity4. Accountability5. Openness6. Honesty7. Leadership

Public servants ‘have a duty to uphold the law and to act on all occasions in accordance with public trust placed in them’.

“Speech is conveniently located midway between thought and action, where it often substitutes for both”.

John Andrew Holmes

How do we get beyond the rhetoric of customer care? By remembering:

“Things do not change, we change”.

Henry David Thoreau