It is time to focus on the “S” in NHS.

We have a National Health Service and like all service industries, success is all about people.   For years, we have been talking about involvement, engagement, participation, co-design, co-development, patient experience, feedback, staff experience, staff engagement, patient-centred, self-management, shared decision making … but, what it is really all about? I think it’s about Human Centred Health. Human Centred Health is about focussing on people – both the people who receive services and the people who work in them. It is about the relational, emotional side of health, the lived experience of services and the involvement of people and their families both in their own health, and as funders/tax payers, influencing how services are designed, delivered and improve over time. It is about the lives of the people who work in the system, all 1.3 million of them, who have to, like actors performing on stage every night, be supported to “get into role”, day after day, in order to deliver the best possible service. Human centred health is about People, Processes and Plans. It’s about recruiting, developing and supporting people to have, amongst other things, the right priorities, attitudes, behaviours, approach and understanding. It’s about knowing that you are making a difference and being clear about where you need to improve. People Do we work in genuine partnership with our local population and the people who use our services? Are we doing the right things, for the right people, in the right way? What’s it like to work here? How does our behaviour impact on the people we work with and for? Is there strong, visible support for human centred... read more

Is it time to consider offering people payment for involvement and co-design activities?

For years there has been the expectation that people will give their time for free to help health organisations to make decisions about how to improve, what services to offer and whether they are offering a high quality service. We are now starting to have a split, with some organisations offering payment for certain activities, others deciding that they will not offer payments at all, and a raft of organisations in-between wondering what on earth to do. The systems needed to offer payments for involvement activities are starting to formalise involvement activity and have the potential to create a more business-like approach, and this, for me, is the outcome that I am most excited about. You need a budget to pay people, an audit trail and a very clear sense of purpose. Paying people requires the service to seriously consider why they are doing a particular activity and what they hope to get out of it. The quality of insight, listening to a wider range of voices and being as inclusive as possible becomes all the more important. Imagine you are an organisation who would like to support a local voluntary sector organisation to deliver service-user-led involvement activities, or you might be hosting a co-design event and offering payment to people taking part – both will require some kind of procurement or payment system. Perhaps by having real money attached to this kind of activity ensures that it won’t be a tick-box exercise. You are not going to spend hundreds of pounds on getting insight that you then won’t use are you? There is much debate about the power differential... read more

Meet the man who could change the way you think about collecting and analysing patient stories

There is an increasing interest in patient stories as they are a fantastic way to engage both the people who use services and those who work in them.  A story can capture key themes that people can immediately understand and relate to and personal stories can help to more easily identify aspects of a service that need to improve. Story collection is a sophisticated art and involves particular systems and skills for the story to really make a difference to the decisions that are made about the way services should be provided.  I am particularly interested in the way that the ground-breaking work of both Healthtalk Online and Wales 1000 Lives is developing to support the collection and use of stories for improvement. A few weeks ago I met Dave Snowden and it has challenged the way that I think about service user stories in health and social care and how we collect them, analyse and attempt to understand them in order to then improve the services we provide. Dave is the chief scientist and founder of Cognitive Edge and describes the way he works as “the intersect between natural science and the social system”.  He is interested in uncovering the way that personal narratives impact on what people do and feel, their motivation and how they behave.  It’s fascinating stuff. Dave is the kind of person who shakes a room.  He has that rare talent to prompt us to question some long held beliefs and assumptions, such as a reliance on surveys to answer questions we have about services we provide.  We should probably call him a disruptor,... read more

The patient experience movement grows up

The service user experience improvement movement is well under-way in the NHS in England. It was born around the time that methods such as experience based co-design were first talked about being used in a health setting. The early years were spent establishing the policy and practice systems and now, patient experience is one of the dimensions of the NHS England Outcomes Framework, there are people in experience posts across the NHS at both strategic and delivery levels, there is NICE guidance for experience and mental health experience and the Friends and Family Test is being rolled out across all services. So, we are entering something that could be described as the teenage phase of the movement – a phase that could bring rapid change, rebellion, risk taking and, for some, serious hard work, before we finally grow up. I like to think that the experience movement started out as “bottom-up”, in that it was about people being more engaged with services and the way that they were delivered. It was about the emotional elements of health and social care – how it feels to be on the receiving end of a service, or to work in a service. It felt like we’d found a new way to make better decisions and identify how things could improve. But, now that all the policy, practice and directives are in place, there is going to be a perception of things being top down that we will all need to understand and work with. For people working in the front-line, the emphasis on data collection, metrics and reporting has the potential to... read more