Emerging Leaders: is patient engagement important in leadership?

Blog by Angela Coulter, Visiting Fellow at The King's Fund.

The Health and Social Care Act has once again resurfaced the debate about patient and public involvement in the provision of health care – with much disappointment being voiced about the cumbersome structure and weak powers allocated to HealthWatch, the latest in a long line of attempts to establish an effective, statutory, consumer voice in the English NHS.

Drawing on experience from other sectors, The King’s Fund called for HealthWatch to be given sufficient powers to act as a consumer champion and counterbalance Monitor’s powerful position as economic regulator. Meanwhile, peers have debated at great length whether establishing HealthWatch as a committee of the Care Quality Commission gives it sufficient status and authority. HealthWatch might yet develop into the effective body that activists are calling for, or it may turn out to be another damp squib, but isn’t the obsession with organisational structures missing the point?

Not everyone wants to join a committee to sit around a table with managers and health professionals talking in incomprehensible jargon. If only NHS staff could be persuaded to do a better job of engaging individual patients in their own care, the effect on health outcomes could be far more dramatic than the sum total of all those extra meetings, consultations and service reviews that HealthWatch will be expected to endorse.

In most NHS organisations, leadership responsibility for patient and public engagement forms a small part of a very busy person’s role, often squeezed out by competing priorities. A visitor from Mars landing in one of a multitude of NHS trusts would have little difficulty finding out who leads on patient safety or clinical governance, but they’d probably have to search long and hard to find the person in charge of improving patients’ experience.

The very fortunate Martian whose spaceship touched down in one of the tiny handful of trusts with a Director of Patient Experience would immediately notice the difference. There he would find a senior clinical leader with a clear vision and a brief to improve patient engagement and patient experience across the organisation. Strong support from the Chief Executive and board gives the Director the clout to get things moving. Patients and carers are actively involved on committees and other decision-making forums, but even more importantly, all staff know they must do everything in their power to ensure that individual patients have a say in the decisions that affect them, particularly decisions about their clinical care.

‘Nothing about me without me’ is the guiding principle in this organisation, respected by all. These patient-centred values are effectively communicated and regularly reinforced at every level, from board to management to frontline staff to patients and families. They are also incorporated into human resource policies, helping to determine the way staff are recruited, trained and rewarded. Special training is available for all staff in communication skills, customer service, and quality improvement methods. Innovative ideas from both staff and patients are welcomed and resources are made available to implement improvements.

Experience has shown that small, inexpensive changes to the physical environment can often yield considerable dividends in terms of improved patient satisfaction. But, as our Point of Care programme has demonstrated, the most effective changes can be relational – transforming the interactions between patients and the staff they come into contact with, and ensuring responsiveness to patients’ needs and preferences. Continuous patient feedback, using both narrative methods and surveys, ensures that progress is monitored, excellent practice is noted and rewarded, and any problems are tackled speedily.

Our visitor from outer space may notice that staff morale in this organisation is exceptionally good and patients are hugely appreciative of the care they receive. Happy staff make happy patients, and vice versa. If he’s very perceptive, he might also realise that health outcomes in this organisation are better than the norm, because patients who are well informed and well supported are more likely to make informed and personally relevant decisions about their health, adhere better to treatment regimes, experience fewer medical errors and side effects, and use less health care. It might even dawn on him that strengthening responsiveness to patients is the best way to ensure the long-term sustainability of public health services.

Find out more about our review of leadership in the NHS

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