Can the NHS learn from Mary Queen of Shops?

Mary Portas: ‘queen of shops’, government advisor on the high street and TV presenter. In Channel 4’s Secret Shopper, the no-nonsense retail guru took some of the nation’s biggest retailers to task over their lack of customer service culture and poor customer experience. She concluded that:

• the customer experience in store is an integral part of customer service
• giving staff the necessary training to ensure they meet the requirements of the customer is crucial
• staff and organisations must understand what customers want.

Take out ‘customer’ and substitute it with ‘patient’; take out ‘store’ and substitute it with ‘hospital’ or ‘general practice’ and perhaps we have a plan that will put the patient’s experience centre stage.

High street retailers train their staff in good customer service. Yet we seem to assume that NHS staff have treating people with dignity and respect, supporting them to understand their choices and involving them in decisions about their care and treatment engrained in their DNA. In reality, staff can often appear immune to anxiety, excessive waiting, impersonal and unnecessarily distressing experiences; they can walk past or participate in care that isn't delivering a good experience.

Every day NHS staff confront mortality and bear the burden of enormous responsibilities, stretched resources and what might feel like constant change. Is this an explanation, an excuse or a symptom of a systemic failure and a personal challenge to put the experience of people who use services at the heart of services?

What are your experiences of health services? Was it like the MP who recently described how her deaf father and she were ignored while the ‘team’ spoke about him around his bed? Was it like my grandfather’s when the hospital lost his teeth? He went home and died before they sorted new ones. Do you walk out of consultations feeling that you were listened to or that you were heard, given information or that you were informed? Do you feel guilty for failing to look after yourself or do you feel supported to make changes to improve your health?

The findings of the Francis Inquiry and the Commission on Dignity in Care for Older People make it clear that too often patients are at the receiving end of unacceptably poor care. And research published today by The King’s Fund and Picker Institute finds a lack of consistency in patients’ experience of care across NHS trusts.

Recently, the National Institute for Health and Clinical Excellence (NICE) published Patient experience in adult NHS services. This guidance and associated quality standards clearly put the principle of high quality patient experience at the heart of good clinical care. This is an important step forward for patients, providing some statutory weight to complement the recent recommendations on dignity in care from the Commission on Dignity in Care for Older People.

But as Mary Portas found on the high street, improvements to customer experience do not occur unless attitudes, behaviours and culture change. NICE’s guidance gives direction and aspiration – but it needs to be supported by action at the front line. Where retail staff are trained to in meeting customer requirements, NHS staff also need the training, development, support and appraisal to be confident they have the skills to deliver person-centred care. Staff need feedback from robust and consistent measures of patient experience so that they can learn and change. In the ‘caring professions’, recruitment needs to take account of relational as well as technical skill.

NICE’s guidance is focused on patients’ experience within traditional healthcare settings, such as hospitals or GP surgeries. But for patient experience to be truly meaningful it needs to go beyond these boundaries. Nearly a third of the UK population live with a long-term condition – and the number is rising. For this population, self-management is the reality.

We need to recognise people’s role in managing their own health and support them to develop the knowledge and skills to become confident self-managers. Last year, the Health Foundation published Helping people help themselves, which found that proactive, behavioural focused interventions designed to increase self-management had a positive impact on people’s quality of life, as well as clinical symptoms and outcomes. 

NICE has laid the foundations for putting people at the heart of its guidance. I hope it will build on this by ensuring that person-centred support is at the heart of all future guidance. I also hope that it will look to the world of self management, and that the Department of Health will ask it to create separate guidance and standards on self-management support. While a customer’s experience may end as they step out the shop door, for people with long-term conditions their experience continues every moment of every day.

To read more about the Health Foundation's views on the NICE patient experience guidance, please read our co-authored editorial on the BMJ website.

Adrian is Assistant Director (Strategy: Changing Relationships) at the Health Foundation.