Patient experience, System design

Small actions speak volumes to patients and help put them at the centre of care, says David Worskett

david-worksett3Why is it so hard to put patients at the centre of care? Despite the very best intentions of so many professional and dedicated staff, in the tug-of-war between system and patient, the system so often wins.

Part of the problem is that patients are at their most vulnerable when they are ill – frightened and confused, caught in a strange new world. And as our clinical care has become more sophisticated, it can so easily become less personal and increasingly daunting. The personal touch that matters so much to patients has to some extent fallen victim to the extraordinary success of modern medicine.

This isn’t unique to healthcare. It’s a trend that has swept across society generally. Small ‘people-centred’ local schools and shops have been replaced by large academies and out-of-town supermarkets. We live in a world of multi-nationals and huge conglomerates and we’re all just small fry in a fast-paced, stony-faced global village.

In healthcare, the stakes are higher than in other industries because successful healthcare invariably needs to take account of the ‘whole person’, not just the narrow symptoms of a specific condition.

But the NHS is going through a huge reorganisation, making it all too easy to focus on systems and not patients, even though the object of the reforms was to “put patients at the centre of our NHS”. Reorganisation, combined with financial pressures and increasing demand, now confronts the NHS with a perfect storm which will push it to breaking point. It’s hardly surprising that the care is at risk of being squeezed out of healthcare.

How can we counter this and ensure that patients are back at the centre of care? The solutions are out there. And they don’t necessarily need major or costly changes within an organisation. As in may industries, ‘doing it right’ will be cheaper than ‘doing it wrong’.

There are NHS organisations – both public and independent sector – who already get it right. Not just the clinical care but the whole healthcare package. These are the places where staff go out of their way to ensure the patient is always at the heart of what they do, and patients consistently rate their care as outstanding. It is to these organisations that we must look.

So what do they do that really makes them stand out? Often surprisingly small things that may seem of little consequence to system managers.

Of course the clinical care has to be of the highest standard, but patients see their care from a wider perspective. According to the NHS Institute for Innovation and Improvement, patients care about their overall experience as much as clinical effectiveness and safety. They want to feel informed, supported and listened to so they can make meaningful decisions about their care. They want to be treated as a person, not a number or a condition.

Some of these wider aspects of care matter to all patients and they should be ‘givens’ just as much as clinical excellence. But the real hallmarks of patient-centred care are the personalised, individual details.

Small actions, often unrelated to clinical care, can speak volumes to a patient. A porter who shares a joke with a nervous patient; a consultant who phones an anxious daughter when her mother’s surgery takes longer than expected; a chef who stays late to make soup for a frail elderly patient. These examples have one thing in common; they are responses to the individual, specific to time, place and person. The pivotal role of staff is underlined by research from Dr Foster, which shows that the word most often mentioned in both positive and negative comments by patients is ‘staff’.

These examples also show it’s not just clinical staff who matter. From consultants to cleaners, everyone in the team can make a difference, and the team has to have shared values and commitment to a culture that always reinforces the personal touch, not just the system basics.

David Worskett is chief executive of the NHS Partners Network


David will chair an NHS Partners Network session exploring putting patients at the centre of care at the NHS Confederation annual conference and exhibition, 5 to 7 June in Liverpool:

Help, I need somebody…Putting patients at the centre of care – Thursday 6 June 2pm to 3.30pm.

The Beatles’ famous song Help! was not about patients, but it could have been with the famous lines:  Help me if you can, I’m feeling down, And I do appreciate you being round. Help me, get my feet back on the ground … ”

Join this interactive session to hear from patients whose care was transformed by exceptional individuals – from consultants to cleaners – who helped them get their feet back on the ground.  And those exceptional individuals tell us why they go out of their way to ensure patients appreciate them being around. Find out what small changes your organisation can make to improve patient experience and help ensure patients are really at the centre of care.


Dr Charles Alessi – Chair, National Association of Primary Care
Jeremy Taylor – Chief Executive, National Voices
Rachel Dixon – Director of Clinical Services, Horder Healthcare
Ruth Holt – Director of Nursing, NHS Confederation
John Buxton – Patient

Follow the conference on twitter @nhsc_conference #NHSConfed13

About NHSConfed .

The NHS Confederation is the membership body for the full range of organisations that commission and provide NHS services. We are the only body to bring together and speak on behalf of the whole NHS. We have offices in England, Wales (the Welsh NHS Confederation) and Northern Ireland (Northern Ireland Confederation for Health and Social Care) and provide a subscription service for NHS organisations in Scotland.


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