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Patient engagement: good news for opticians and cardiologists


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Friday, 1 July 2011

Patient engagement: good news for opticians and cardiologists

Patients are a nuisance. They get ill because they don’t take enough care of their health. They have accidents, many of which could be avoided if they drank less, drove slower and played less dangerous sport.

They are not grateful enough when you give them help and if you don’t help they become violent and abusive.

The deserving sick don’t want to waste your time. Everybody else can’t get enough of it.  

No wonder patient engagement is a subject that makes eyes roll and hearts sink.
Very few people really believe that greater involvement of patients will do any good – including patients themselves.

This is because attempts to “involve” or “engage” with patients are patronising or half-baked and usually both. Patients are only really consulted in order to make what they were going to get anyway more palatable.

The trouble is that patient engagement is still seen as a marginal activity, an extra-curricular interest, a hobby. It certainly isn’t seen as part of the day job for most health professionals and even those who recognise its importance don’t really know how to do it.

There are some useful clues about the real value of patient engagement in an article about NHS Hertfordshire in last week’s Health Service Journal.

Here are some of the main lessons:

• Patient engagement is core business not a side show. If you don’t put any effort in you won’t get anything out.

• You’ll need to get out of the office to make a difference. Only people who already like you will turn up and drink your coffee and eat your biscuits. Everyone else needs persuading.

• Make a plan. It’s not enough to have feelings and convictions.

• Don’t do it if you’re just going to dabble. Do it at scale.

• Go forth and engage with patients in their natural habitats. Why would they come to you? Hertfordshire went to traveller sites and other easily locations usually avoided by polite middle-class people with medical backgrounds.

• Involving patients in service design makes them better service users and better ambassadors for good use of services.

• Just because people are engaged won’t stop things going wrong, but it means that communications will be easier and the damage is likely to be less extensive.

• Focus on clinical issues and don’t get distracted by anything else.

What is striking about the Hertfordshire story is the scale of the enterprise, the variety of techniques used to get people involved and the systematic way in which it was done.

If your patient group is not broadly representative of your population, you’re wasting your time. Two per cent of the population is a good target. That’s the percentage return marketing people used to hope for in direct mail campaigns.

It’s too many people for a meeting but not too many to have following you on Twitter or regularly visiting your website.

The main lesson from the Hertfordshire experience is that engagement takes time. The HSJ’s case study spans three years during which Hertfordshire made a good start. In another three or five years it may be making good progress and in the space of a decade it may be judged a success.

Patients may be annoying, but they can spot a fake a mile off. Doing patient engagement badly is worse than not doing it all.


Lubiloo says:
Jul 01, 2011 10:52 AM
mark.buckle@journey-group.com says:
Jul 01, 2011 11:17 AM
You are right in observing that 'patient engagement' has always been a cottage industry within the NHS. Who could possibly disagree with the 'no decision about me' principle as a principle. Except that it's wholly unworkable, unrealistic and, one might suspect, 'un-wanted' by the public. Do we imagine Tesco would adopt this principle in order to align itself more fully with its customers? Lovely thought, but never ever likely to be commercially viable.

The fact remains that the NHS plays at 'listening' to the public. Why? Because the leadership views the public through the same eyes as politicians. If the exam question is 'how do we DESIGN services that are effective from the perspective of public and patients, and are DEVELOPED on a consistent basis and then DELIVERED efficiently?' the answer to the question would not be to hold meetings in town halls with the usual suspects.

The key words are those in caps: It's how profitable services are designed in the commercial sector and if you substitute the P-word 'profitable' for the S-word 'sustainable' in healthcare, we might begin to move away from those efforts that keep the NHS busy (PPE/PPI et al) - but have never provided any evidence of system-wide benefit - towards a proper planning regime with longer-term objectives and outcomes horizons. In summary, the NHS has to learn (as a system) how to DESIGN (effectiveness), DEVELOP (consistency) and DELIVER (efficiency) services that result in staff 'delivering things right first time, every time.' And it's NOT just about process improvement, it's about how 'the people' (NHS staff) are enabled to deliver a first class interface with the public, SUPPORTED by relevant and effective processes.

When we have an enjoyable experience at our favourite grocery retailer, the reality is that many, many decisions have been made 'about me' (my needs and, significantly, my expectations...) without anyone making any direct contact with me, seeking my views, letalone my demands. It's not affordable to do so on 1-2-1 basis. So although at face value it may appear to be an 'ideal' relationship with the public, in reality it is, and always will be, wholly unsustainable.

Let's hope the NHS leadership moves on from this simplistic perspective as quickly as possible. That the new National Commissioning Board has a national lead for 'Insight' is hopefully a step in the right, longer-term direction. But the real battle will inevitably be in securing a long-term, sustainable future for the NHS that avoids the pitfalls of political short-termism and the constant need for high visibility political 'wins.' In short, Effectiveness First should be the new motto of the NHS.
markdrury says:
Jul 03, 2011 11:49 PM
I agree with 99% of this but take issue with the paragraph:

“If your patient group is not broadly representative of your population, you’re wasting your time. Two per cent of the population is a good target. That’s the percentage return marketing people used to hope for in direct mail campaigns. “

I think you are confusing representativeness with reach.

In some circumstances there may be reasons we might want to engage as many people as possible. For example, in a major reconfiguration which will affect a whole population.

However, if the aim is to get a representative sample, statistically that can be done on around 0.2% of the population. When you cite 2% for Direct marketing, that is not to do with sampling, its to do with return on investment.

Whenever we are deciding on a methodology for engagement, there is always a trade off between breath and depth. Do we want a relatively shallow engagement with lots of people or an in-depth engagement with much fewer people.

Citizens juries are at the far end of the scale with maybe as few as a dozen people looking at an issue in great depth – this is a useful methodology for complex issues (see http://www.oldhamhealthcommission.org.uk)

So you can have a representative or reflective sample with what might appear to be a small sample sizes. However, unless we ensure that smaller group is truly representative we really are wasting our time.

Mark Drury, NHS Oldham
jpatterson says:
Jul 04, 2011 12:47 AM
You're absolutely right. Representation is a variable not an absolute. And the right scale will often be small.
cgleeson says:
Jul 04, 2011 10:00 AM
Agree with the author and many of the subsequent comments. It's all about attitudes - commitment of staff to engaging with patients on their terms. Many individual staff do this anyway, but systmatic 'patient engagement' is often a 'tick box' ecercise which is pretty much a waste of time. Our Lirklees LINk survey of GP practises showed that just one (of 67 practices) had a patient forum. As pointed out in the above discussions, NHS managers need commitment to exploring views of patients in diverse and complex situations. For staff providing care for long term conditions, having a good understanding of local cultural beliefs is crucial to getting good patient outcomes.
DMalik says:
Jul 07, 2011 02:54 PM
Many people don't view the NHS as a 'business' and therefore don't always think in business terms, yet it is absolutely in the business of patient care and therefore patient (or customer) engagement is imperative to it's future sustainability.

Whilst there is value is 'getting out of the office' and 'visiting patients in their own environments', there is even more value and return in focussing on the front-line and the patient/customer experience. Anyone in business know that the most effective tool for marketing by far is word of mouth and this is why the world is embracing the power of social networking vehicles to get their messages across (but that's another discussion altogether).

The point I am making is that unhappy or dis-engaged patients will tell on average 22 people of their experience, which hardly supports customer engagement and could totally counteract any efforts/initiatives in patient engagement elsewhere. Address and embrace patient engagement on the frontline and you'll be on your way.

It's not always about introducing new processes or new inititiative that need to be introduced in addition to already huge workloads, it's about doing things differently to change behaviours. It's about working smarter, working more efficiently and focussing on an outcome of excellence in patient care with increased engagement.
DMalik says:
Jul 08, 2011 12:21 PM
Just seen a post on Twitter by a 16 year old girl "Hmm.. How useless is the NHS these days?" - she has around 300 followers and I'm guessing many of these are around the same age. Dis-engagement from such an early age is concerning and with the vehicles to broadcast views so widely being so readily available, this is something to pay attention to.