Originally published 16 April 2013. This article is retained from the tCI archive. Law, policy or practice may have changed since publication.
Last week, the re-organised NHS in England started in earnest to use a single standard benchmark question.
It reads: “How likely are you to recommend our “ward/A&E department” to friends and family if they needed similar care or treatment?” and uses a five point scale with the results shown as the ‘Net promoter score’.
Its advocates point out that this is a quick, consistent and standardised patient experience indicator and it will provide organisations, employees and the public with a simple, easily understandable headline metric, based on near-real-time experience. Critics claim that it is capable of significant manipulation and will obscure far more important patient satisfaction issues. Time will tell soon enough as the scheme is rolled out beyond its initial application in hospital wards – especially when it gets used in doctors’ surgeries.
We might never have had this experiment – were it not for the Mid-Staffs scandal. The context is all-important; the allegation that NHS Managers, Regulators and others besides failed to listen properly. The argument is that poor or worsening scores that are publicly visible act as a safety-valve to prevent problems being ignored. It plays to the transparency lobby perfectly.
But look deeper into the controversy, listen to campaigners like Julie Bailey of CURE the NHS and read the Robert Francis QC Report closely and we find an emerging consensus that what’s needed is a ‘culture-change’. That’s ambitious. It means knowing what behaviour we want to change and finding what steps can be taken that will drive such changes. So can this single killer question push this agenda?
Like all high-profile indicators, the danger is that it becomes an end in itself. As always, efforts will be concentrated on finding ways to improve the headline number and some of these actions will surely be beneficial. But there can also be unforeseen consequences. Critics will argue that short-term satisfaction/popularity – which is what is measured in the Friends and Family test – may be improved through better cosmetic have a nice day-type initiatives at the expense of quality initiatives that only improve outcomes in the longer-term. The overall experience, they argue, is a much more complex mix of factors, truly measurable only with a 360-degree perspective.
So let’s apply this analysis to the wider world of consultation. On what occasions can we successfully manage the debate by placing most emphasis on a single killer question?
Conventional thinking is that it is most unwise to reduce complex issues to a yes/no question, even though the public often sees it in those terms. Planning permissions, housing developments, roads, railways, airports, windfarms, power stations and all manner of required infrastructure projects generate arguments that appear to lend themselves to a ballot-box vote. Indeed, neighbourhood planning in England will see us all get used to Referendums on local plans, so people will definitely start thinking in terms of votes cast. Add to this the growing popularity of e-petitions and the relative ease with which campaigners can attract tens of thousands of signatures to demonstrate the popularity of their cause.
But many consultations are more subtle than yes/no. And more complex than How satisfied are you? Changes to public services, including maybe closures of cherished facilities, usually involve helping the public become accustomed to different ways of delivering and using services. Be they libraries, police stations, post offices, or even maybe entitlement to benefits, these are all more difficult than any yes/no question can deal with. They involve identifying priority needs and exploring different ways of satisfying them. Ideally they are approached in the spirit of co-production, with expert users or expert customers sitting down with commissioners to identify solutions and propose alternatives that can then be considered through consultative processes.
Wise heads in the health and social care fields recognise that financial, demographic and operational challenges lying ahead will require a fundamentally different approach. That is why so much will depend upon the new Health & Wellbeing Boards whose job it is to devise a do-able strategy for their areas, and to engage well enough with local people to carry them along with them in possibly difficult decisions. The single question may well be an important indicator, but is but one of many elements of public and patient opinion that will need to be understood monitored and responded to. True consultation needs so much more.
Trigger Points
- Julie Bailey’s views from CURE the NHS will be very relevant to local authorities, NHS Managers and those with responsibility for patient and public involvement. Come to talk to her at the Institute’s Will Health & Wellbeing Boards succeed in engaging communities? Roundtable in Birmingham on 14th May. For further details please click here. The page also includes a video introduction by Rhion Jones.
- Does your organisation use a single headline measure as a source of customer experience measurement?
- Do you take steps to avoid consultations being reduced to a yes/no question?
- For details of the Friends and Family survey methodology, click here.
- Some of the issues covered in this Topic are covered in the Institute’s new Masterclass on Health & Social Care
- For Clinical Commissioning Groups (CCGs) in England, the Institute has developed brand new packages for membership and training. Please contact Martin Roach on 01767 318350 or email hello@consultationinstitute.org for details.
This is the 234th Tuesday Topic; a full list of subjects covered is available for Institute members and is a valuable resource covering so many aspects of consultation and engagement