How many times a week do you hear this phrase? Probably every time you call your bank, insurance company, local authority or online retailer. So often that you've probably stopped hearing it. But there is one service sector where to hear this would probably take most of us by surprise: healthcare.
Yet, given what we know about how the quality of the dialogue between clinician and patient can impact on experience, satisfaction and indeed outcomes, isn't it time that recording of consultations became the norm?
We're supporting two programmes that focus on changing clinical consultations. Co-creating Health is adapting traditional consultation techniques to embed communication strategies that are shown to increase individuals’ motivation to self manage and take more responsibility for their care.
In doing so, people living with long-term conditions are shown to be better equipped to manage their condition, engage in health promoting behaviours and depend less on healthcare.
The second programme, MAGIC (Making Good Decisions in Collaboration), looks at how patients can become active partners in decision making around treatment choices. This too requires clinicians to adopt very different consultation techniques that help people identify their values and preferences such that they can make treatment decisions that work best for them. The evidence that this results in better outcomes (and often lower costs) is well rehearsed.
However, one of the challenges we are finding in both these programmes is how to know whether or not clinical practice is changing. Outcome measures such as changes in service utilisation and clinical markers are longer term measures and hard, in an improvement (as opposed to research) setting, to attribute to specific interventions.
Patient feedback tools are found to be insensitive to change – generally patients have relatively low expectations of their level of involvement and participation in clinical consultations, so this creates the appearance of there being little headroom to improve.
Clinicians have embraced clinical audit of their practice on process and outcome measures, and some surgical specialities are now videoing operations. Is recording and random sampling of consultations the next frontier for clinical audit? Some general practices have started experimenting with recording advice calls and have found that the quality of the advice improves.
The technology to record routine consultations exists, as do tools to assess the quality of interactions for attributes of motivational interviewing and shared decision making. This could be linked to appraisal and revalidation. It could inform comparative information to support people making choices of provider.
Clearly this idea for many will be heretical, touching on sensitive themes of patient confidentiality and the inner sanctum of the clinical consultation. Control over whether recordings are made, and kept, would need to rest with the patient to protect their rights to confidentiality.
But we know time and again that having the right measures are effective drivers for real change. At the moment we don’t have adequate measures to generate real-time feedback on the quality of clinical consultations. Isn’t it about time?
Jo is Director of Improvement Programmes at the Health Foundation.