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Time to dump the e-word


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Friday, 28 June 2013

Time to dump the e-word

All over the NHS earnest, well-meaning people are busy engaging. Engagement is often “strategic”, always “meaningful” and mostly useless. Everywhere you look there are models, methodologies, frameworks and systems for something few people understand and even fewer want.

You can buy books about it, go on a course to learn it and make a living peddling it – not a bad living either, because there’s no danger that success will undermine demand.

As long as people are disinterested, preoccupied with their own lives and suspicious of solicitous strangers with clipboards and brown shoes they will remain disengaged. As long as there are Facebook, Eastenders and MacDonalds they will be hard to reach.

Try engaging with people in the street or the pub and at best you’ll get funny looks. Try too hard and you’ll end up with a thick lip or a caution for harassment.  It is no coincidence that engagement works best with the sick, the bedridden and the desperate – those who lack the capacity to get away.

Engagement is an industry with no products, a community where no one wants to live. So why do we persist in the belief that the NHS will fail without it?

It is a symptom of our inability to see the world from the world’s point of view. Like Victorian missionaries we need to save the savages from their ignorance. They had Christianity; we offer salvation through engagement. They will thank us for it later.

Engagement and its weasily little sidekick “patient-centred care” are admissions of failure. What does it say about a 65 year-old organisation that it has only just discovered who its customers are and is still struggling to talk to them?

Imagine Ford introducing a “driver-centred” car or Asda opening a “customer-centred” store. Would you fly with an airline for which being “passenger-centred” was still something of an aspiration?

In every other field, engagement is not a process or a tool but a product of good customer service, a station you pass through without noticing en route to satisfaction; it’s what you get when you give people what they want.

We even have a four-letter word for it: care.


Caroline Morris
Caroline Morris says:
Jun 28, 2013 11:45 AM
Refreshing to hear you spell it out so articulately ..
Dr. Chris Gillespie
Dr. Chris Gillespie says:
Jun 28, 2013 11:49 AM
As NHS psychologists we are very familiar with this phenomenon. We call it semantic satiation.
Garrett Turbett
Garrett Turbett says:
Jun 28, 2013 12:08 PM

Smart Guides to Engagement: http://www.networks.nhs.uk/network-resources

That's me confused!

NHS Networks
Julian Patterson says:
Jun 28, 2013 04:41 PM
Garrett, well yes. That was then... :-)
Philip Coulthard
Philip Coulthard says:
Jun 28, 2013 12:20 PM
There was a banker called Dee Hock. He set up a little known organisation called VISA. His book on Chaordic organizations is available on line. Unless you are part of the community you are unlikely to engage with it. It seems the case that most large organizations sadly loose a sense of community. Chaordic structures are based on small self organising groups. Has anyone in your organization investigated such possibilities for change?


Paul Buchanan
Paul Buchanan says:
Jun 28, 2013 12:34 PM
Beautifully said - very few have the audacity to challenge the plethora of 'new-age' NHS Managers/CEO's/Engagement Specialists about spending such ridiculous amounts of time/energy/money on 'social media engagement' I was branded a pariah!

SociaMedia as a magic wand for 'engagement' - the Emperors New Clothes, how nakedly ridiculous!
Kate Thomson
Kate Thomson says:
Oct 21, 2013 08:31 PM
It is ridiculous if it is done badly and should be challenged. But if there are groups of people who only use their mobiles for communication then you need to communicate with them using mobiles.
Tony Lloyd
Tony Lloyd says:
Jun 28, 2013 01:43 PM
Engagement is more about giving patients and patient groups the power to refocus healthcare professionals away from targets and back to decent standards of care. If it's an industry then I've never been paid a wage. If people are disinterested it's because patient groups are patronised by healthcare administrators and their views and recommendations are routinely ignored if they are in conflict with what has already been decided behind closed doors. Good transparent engagement prevents abuse. Much of what now passes for NHS engagement is meaningless window dressing. Very few people have the faintest idea of how to go about engagement and the bulk of the funds spent on engagement are wasted. Unfortunately too many people have a vested interest in perpetuating this mediocrity.
Julian Simcox
Julian Simcox says:
Jun 28, 2013 03:50 PM
Engagement as a concept is fundamentally flawed. The only kind of engagement that makes any real sense is “self-engagement” for, to paraphrase the late great management consultant Peter Scholtes, it may be the very height of arrogance for any one human being to assume that they can engage another – in practice all they can do is disengage them!

For me, the only way forwards is for patients to self-engage, and put themselves forward for discovering: FIRST about how to take charge of their own care, and SECOND about how to take charge of their community’s care. In recent years much has been said about the conflict between clinical leaders and managerial leaders, but to my mind the time is ripe for the Patient Leader : Local Champions who know how to monitor local services and who with a little training can elicit improvement simply by ensuring that managers and clinicians have some real data – collected over time – to reference.
The new Friends & Family Test for example could help if the data is used on the frontline to identify daily variation in outcomes. Sadly the data is likely to be used largely as just one more quarterly target with which to beat-up middle managers, but even a lightly trained Patient Leader should be able to make it the basis for local improvement by those who actually work IN the system.. people who might with hindsight subsequently be described as “engaged” but who will actually merely have been infected with self-engagement by the self-engaged Patient Leader.

Anonymous says:
Jun 28, 2013 10:44 PM
let's bring in the f-word
the NHS was created to enable people to give a helping hand to other people, not to provide employment to talkers and academics - non doers belong in the word of politics and education.
Tom Bell
Tom Bell says:
Jul 04, 2013 09:26 AM
Let's put this conversation on the right foundation and acknowledge that the customer has been the funder and not the patient. The arrival of competition may start to change that; we can hope.

Then, let's get comfortable with the word "Marketing" and start to do it well.
Kate Thomson
Kate Thomson says:
Oct 21, 2013 08:27 PM
Engagement is a product of good customer service but I don’t think we are giving all the people what they want. The student wants reliable medical information, the housebound carer longs for interaction and advice, the businessman wants an email consultation. With Facebook etc. we have the ability to improve our engagement with patients. GPs need to stop thinking fax machines are the only technology they need to interact with the outside world.