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 kill any personal interest in improving the actual experience for service users and their families. As an experience lead said to me recently, “We risk becoming metric heavy and information poor”.
Meaningful feedback cycles
For this to work, we need to take everyone with us and make sure that the data collection, analysis and reporting is meaningful. The information gained from asking service users about their experience needs to return to the place where it will make the biggest difference to patients. There is no point in collecting information to feed a big number crunching beast. The people who deliver health services, who are best placed to make positive changes, need to see and understand their service picture of the patient experience as it develops and have the time and space to share how they can make things better. Often it is this “how” of change, having the time to meet and talk to others in the system, to articulate the “how”, share ideas and ways of working that makes the biggest difference. We need to be given space and time to try some different ways of working, to test ideas and monitor their success.
“We risk becoming metric heavy and information poor.”
And for the people who will be completing surveys, taking part in interviews and focus groups and maybe even participating in co-design activities, there will need to be clear evidence that their participation is making a difference. They too need to see the fruit of the labour and the value of the personal time that they give to support public services.