Healthcare delivery
staff in their mission to provide good care for patients. Observations showed that staff wasted time working with poorly designed IT systems, negotiating clinical pathways with obstructions and gaps, and battling with multiple professional groups and subsystems. These examples were mentioned for pharmacy, microbiology and imaging, as well as many others. Dixon Woods’ analysis identifies how many of the aspects they discovered can be improved. First, clear explicit goals that are coherent from ward to Whitehall are essential. Second, organisations need intelligence: they need to know how well they are doing really as an organisation, and where they need to improve. This means actively seeking uncomfortable and challenging information from patients and staff, rather than relying solely on formal data collection against narrow performance indicators that may not give a fully rounded picture of quality of care. Thirdly, organisations must constantly review,
strengthen and improve their systems, which may be required at many different levels, from smoothing patient pathways to improving communication, teamwork, assuring that clinical areas are staffed with the right kind of skills, as well as ensuring personal development, equipment standardisation and training. Organisations also need to focus on developing cultures that are person-centred (not just task- focused) by valuing and building on the excellent care and commitment delivered by many staff throughout the NHS.8
Conclusion It is fundamental to healthcare that patients have trust in the healthcare system as they interact with it. They need to be reassured that the clinicians they meet have their best interests at heart, can communicate effectively and are not so busy that they have no time to listen to worries and concerns. A person’s experience starts from their very first contact and follows through to their last, which may include end of life care. It covers all the sectors of the healthcare system – whether primary,
community or acute care, or the ambulance service. All of these add to the persons’ view that they are getting the correct care by compassionate and caring people. There are many good elements of the patient’s journey and professionals who deliver appropriate and excellent care, but trust can equally be lost in a short time. There have been many media reports that the public are less supportive of the NHS in the last few years than ever before. Many people report that the reason for their concern is increasing difficulty in accessing primary care, having to wait a long time for an appointment, and the repeated media reports of how long the waiting list for treatment in the hospital may be. Equally, those who have interaction with healthcare, often report general satisfaction with the service. However, it is often the detail that reveals the issues, which the management of the area needs to know and be empowered to resolve. This may take longer, as these data are rarely collected and fed back to the relevant area. There is a great deal more work to do, if the patient experience is to be improved overall and faith restored.
References 1. Radio 4 Today programme interview with Merope Mills. October 2023
About the author
Kate Woodhead, Technical Editor for CSJ spent many years working in Operating Theatres in the NHS before setting up her own consultancy business. She was Chair of National Association of Theatre Nurses and President of the International Federation of Perioperative Nurses. In her spare time, she Chairs Friends of African Nursing, a UK based charity.
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2. Doyle C., Lennox L, Bell D. A systematic review of the evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open, 2013;3:e001570
3. Ibid 4. Wellings D. The King’s Fund October 2023 Patient experience: who is listening? Blog.
5. World Health Organization 2023. Patient safety rights charter. Accessed at Patient Safety Rights Charter (Draft) (
patientsafetycommissioner.org.uk)
6. Richards T. 2023 Improving patient safety by shifting power from health professionals to patients. BMJ 2023;383:p2278
7. Dixon-Woods M, Baker R, Charles K, et al. Culture and behaviour in the English NHS: overview of lessons from a large multimethod study, BMJ Qual Saf, 2014;23:106–115.
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