long. The patient does not develop a long-term relationship with the service, and means we provide a good service’.
so has little incentive to improve the service. In oncology, patients may make
several visits, but they are, understandably, so wrapped up in the process of their If a sufficiently large return is received, the wide range of needs and requirements
treatment that they have neither time nor energy to become involved in service can lead to further excuses: ‘we can’t do everything so, to avoid upsetting any
improvement activities. Patients may come from a wide geographical area and respondent, we’ll do nothing’.
may be unwilling to make the effort to become further involved with a service.
Patients can be invited to say what is wrong with a service but may then be
The next challenge is to get those patients willing to become involved to expected to leave it to service professionals to decide what to do about the issues.
contribute constructively. Not all patients are useful: some have their own agenda, Work on patient consultation can be given to busy staff who do not have the time
and some are unable to relate particular experience to wider concerns. Some
Giving patients
to do anything worthwhile, or to staff of such a grade that they are left out when
patients are so grateful for their treatment that they have nothing but praise to decision-making meetings are held and are unable to influence the nature of the
offer – flattering, but not especially helpful for service improvement. Other patients
a good feeling
decisions made.
have nothing to offer but minor whinges born of their own idiosyncracies. Yet
others are unwilling to be critical because they fear that their remarks will affect
about their care
Patients who actually respond to invitations and attend meetings can be listened
adversely individual members of staff or, indeed, care they may need in the future. to and then sidelined in post-meeting discussion amongst the professionals
can be clinically
because ‘that’s a one-off incident’, ‘they’re not representative’, ‘they don’t
One way of addressing this challenge is to rely on random anonymous surveys understand the issues’ or ‘it’s just not possible to do that’. The worst piece of
and questionnaires. But, as was suggested above, this is insufficient for service
beneficial
tokenism is to invite patients to contribute to discussion but then fail to give
improvement purposes. If that suggestion is correct, then patients must be brought them any feedback on what happened next or any reasons for not doing what
together in some way for constructive engagement with the relevant service they suggested. In the face of this kind of tokenism, it is no wonder that patients
improvement teams. This poses further challenges. Timing is difficult. Patients become disillusioned and decline to participate further.
have many other things to do and are not always available at times which suit
the schedules of busy professionals. Even if meetings can be arranged, many lay Overcoming tokenism in patient involvement
people clam up when faced with a body of professionals, however pleasant and To overcome the challenges and avoid tokenism, it is necessary to recognise that
welcoming. involving patients in service improvement is demanding. Like all useful service
improvement activity, meaningful patient involvement requires the investment of
A third challenge is that patients generally are not aware of and do not understand significant resources. A service improvement team which is committed to involving
the structures and processes of the NHS or other healthcare providers. Nor do patients will have a member whose primary function is patient involvement. That
they understand the constraints under which services must work. Management person will seek actively to involve patients in various ways, and will respond
hierarchies, budget processes and policy directives are of no interest to the patient. actively to them.
This is not because patients are unfamiliar with management, budgets and policy
directives; on the contrary, patients also grapple with such things on a daily basis. The person who takes on this role will need particular skills and aptitudes. One
However, patients have been told by politicians that healthcare services must vital asset is empathy, the ability to see and feel the service from the perspective
be responsive to them as patients, and as taxpayers they believe, rightly, that of the patient. Communication skills are another obvious requirement. On the
they fund healthcare services. Consequently, they view service improvement as one hand, listening skills are needed but this listening involves relating what the
something that should happen in spite of any apparent constraints. patient is saying about how it felt to pass through the service, to what the service
looks like from the inside and what the service is trying to achieve; on the other
In the face of these and other challenges, it is easy to retreat into unintentional hand, there will be a need to take what the patient says back into the service
tokenism; to go through the motions of consulting patients but being very and feed it into relevant discussions, and afterwards to tell the patient what is
selective about what is done as a result of the consultation. Patient surveys happening, and why.
and questionnaires can be produced and offered, and the results analysed. Poor
return rates can be shrugged off with plausible reasons, such as ‘patients aren’t Flexibility in time management will also be important. It might be necessary
interested’, ‘patients don’t have time’, ‘we did our best’, or, even, ‘no complaints to go to patients rather than have patients come to the service, and that might
26
|
IMAGING & ONCOLOGY
|
2009
Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64