KevinMD tweeted a blog post on customer service today. I’ve happily noticed a number of ‘how does this other field inform medical practice’ type tweets from the docs I follow on Twitter, of late. This post piqued my interest because what does the ‘gung ho’ ‘customer is always right’ brand of American customer service (and indeed but maybe to a lesser extent Canadian customer service) have to say to the NHS?
He says that one of the common tenets that a group of successful companies (including Enterprise Rent a car) is:
Employees are “hired for fit.” If a prospective employee doesn’t radiate service, they are re-directed
This clearly isn’t the case with the NHS nor could it be- employees are hired for specialist knowledge and skills and if their customer service isn’t up to scratch, then this is the hundredth thing on the job spec so they stay put.
I overheard a conversation in which somebody was asking why the receptionist was always rude at the doctor’s office. The answer that was given was that they are the chief gatekeepers for the doctor. Having worked with doctors I agree with this. But also having worked with customers, I understand the need to sometimes put up a barrier against a tide of emotional, stressed and often abusive customers…and I worked in a bookstore! So while I am not exactly criticising the apparent lack of customer focus in doctor’s surgeries and hospitals, I think we need an intervention. I am in favour of a customer service focus. I think the current system is based solely on goodwill and signs asking us not to be abusive (similar to the signs at the Post Office pick up window). Staff are clearly overwhelmed as KevinMD writes in another post. We need more doctors, more surgeries and better customer service.
My new doctor’s surgery has a touch screen system to allow patients to ‘check in’ to their appointment and it succeeds in taking people out of the massive queue for the receptionist. People spend less time queuing, aren’t made late for their appointment and hopefully spend less time thinking angry thoughts. This is a great start and will increase goodwill in patients if not in staff as well.
Regents park in October
I feel strongly that because science is about knowledge and knowledge sharing leads to better outcomes as well as some idealistic notion that truth should be available to all (haha what a minefield) then paying for journal articles from publishers is quite wrong on many levels. This BMJ article ‘Why are we copyrighting science?‘ (BMJ 2010; 341:c4738 doi: 10.1136/bmj.c4738 (Published 16 September 2010)) says open access is a good example of where the rest of medicine can go. The authors lament the lack of freely available rating scales “Rating scales are an integral part of research in psychiatry. Most psychiatry diagnoses do not have external validating criteria, so scales help in structured gathering of information and in use of standard criteria for diagnosis.” Unfortunately even when the original is no longer copyrighted the newer additions become so ‘evergreening’ like drug patent extensions. This has been bleeding into genetics, something ultimately ridiculous as we wander around, living containers of the stuff, should be be paying fees for breathing? “Intellectual property rights in the form of copyright of scientific publications and patents of drugs and genetic material restrict access to vital scientific knowledge.” Quite so.
I noticed today a tender notice from NICE outlining their broad plans for the specialist collections. Here is an abridged version:
“Today, NHS Evidence provides access to 30 collections of specialist evidence content, the ‘Specialist Collections’. In April 2011, NHS Evidence will launch a redesigned and improved specialist evidence service. As well as the technical developments, topic coverage will be extended and greater emphasis will be placed on quality assurance and standardisation of processes and products across topic areas. The current Specialist Collection service is contracted out to 21 distinct organisations (with an overall headcount of approx. 80 staff). The contracts for these services are due to end on 31.3.2011. In order to achieve the quality, consistency and standardisation objectives listed above, NHS Evidence are aiming to rationalise the provision of the core service to three Clinical Hub Centres. One of these will be in-house and Manchester based. The other two will be contracted out. The purpose of this tender is the provision of the service of these two Clinical Hub Centres from 1.4.2011. Each contracted out hub will cover 8 to 10 speciality areas. Key activities of each centre will include hand-picking content from sources routinely ingested by NHS Evidence, searching and identifying content from specialist sources, tagging resources / allocating to an agreed taxonomy, identifying entries for UK DUETs (UK Database of Uncertainties about the Effects of Treatment), preparing and programme managing Evidence Updates on selected key topics within the hub’s remit (there are currently over 60 Evidence Updates in total across all specialist collections, but this number is likely to increase). Managing and quality assuring the activities of each hub will be part of the service.”
There you are then. Make of that what you will. Nervous times for all involved, no doubt. Presumably the Kings Fund will go for one, given that they already manage three of the current specialist collections. Maybe a consortium up in Oxford (Oxford Radcliffe/CEBM)? They have their hands on a few. The University of Surrey currently manage three. The universities of Southampton, Sheffield and Warwick all have experience, as do a few London teaching hospitals (e.g. Royal Free). Any thoughts or inside information from anyone out there?
**Update 9th July**
It has been suggested that idle speculation about who might go for these Hubs is unhelpful, and that given people are stressed because some might lose their jobs etc. that it should best not be discussed. It is also noticeable that, apart from co-blogger Danni (thanks Danni!), there have been no comments made on the post, even though our stats suggest it has been viewed quite a number of times. I suppose I have four things to say:
- I’m just delighted when people other than my Mum read my posts
- We rarely get too many comments anyway *sigh*
- I’m a chatty blogger who likes to idly speculate. I also find it difficult to finish off blog posts. Ending after “… (e.g. Royal Free)” seemed a bit abrupt. I therefore lazily tapped out “Any thoughts or inside information from anyone out there?” just to round off the post in classic blogging style with a meaningless “what do you think” kind of way. I certainly never thought that I would get much response, let alone “Yes, I am a representative of organisation X, and we’re going for it”!
- I am aware that jobs will go, but also that new jobs will be created. I would never make light of the nervousness that we all feel during this time of uncertainty – for better or for worse, none of us have a job for life any more, and we all suffer from job anxiety. I apologise if it seemed to be in bad taste to speculate. However I do maintain that it is a topic of interest to a wide range of people, both inside and outside the NICE/specialist libraries axis, and that it’s right and proper that it is a point of discussion. Of course people on the inside will already have been speculating for a while, and will be much much better informed than I – they also would not start tapping out their inner thoughts on a forum such as this! But there are also people on the outside who are nevertheless interested in what’s going on, and some would be interested in speculation as to what’s going to happen next; and, I would suggest, why wouldn’t they be?
Basically, good luck to anyone who’s going for it, and double good luck for anyone whose job might be affected by it.
So titles an interesting article at pre-publication stage in Implementation Science. It argues that we need to understand how people think AKA the ‘cognitive information processing framework’ before we can understand how evidence can be translated to policy. It actually reads like arguing why the scientific method as opposed to irrational political will or personal bias (even if it is just to find an easy answer as opposed to the best one) should be used to make policy. I don’t know this is possible however when politics is more about opinions of how the world is or should be and science is about evidence and finding the best way to explain something by trying to be objective.
Slightly surprisingly, given that you’d thought that the Tories would use their coalition with the Lib Dems to get out of their policy of “ring fencing” the NHS budget, an FT blog is reporting that the coalition will indeed increase NHS spending in real terms for each year of the parliament:
“The parties agree that funding for the NHS should increase in real terms in each year of the next parliament, while recognising the impact that this decision would have on other departments.”
I guess the “impact on other departments” is that they’ll all have to put up with even bigger cuts than they were already expecting, but it looks like the NHS is sitting pretty.
We don’t do politics here at (the) health informaticist of course, as these things can easily fall into ranting, and we don’t, of course, do ranting…
However I thought it at least worthwhile, and safely non-party political, to pass on the observation that the HSJ has made, that apart from the Health Secretary himself Andy Burnham, all of the other Labour health ministers have lost their seats: Health minister Mike O’Brien was ousted from Warwickshire North, Care services minister Phil Hope lost at Corby, and Public health minister Gillian Merron was booted out (just) at Lincoln. The Conservative shadow health team, on the other hand, remains intact: Anne Milton (Guildford), Mike Penning (Hemel Hempstead), Shadow health secretary Andrew Lansley (Cambridgeshire), Mark Simmonds (Boston and Skegness), and Stephen O’Brien (Eddisbury).
Also, looking at various reports in the HSJ, it seems to be a trend that wherever a local candidate was able to play the “save our NHS” or “save our hospital” or “save our A&E” etc card succesfully, they did awfully well in the polls. For exampe Alan Campbell won at Tynemouth after “challenging the Tories over leaflets suggesting accident and emergency and other services at North Tyneside General Hospital could be cut if Labour won”, the Lib Dems took one of their target seats, Burnley, after their leader Nick Clegg promised that an A&E centre would be re-opened, while a Conservative, Mr Gummer, won in Ipswich after he opposed unpopular plans for regional reconfiguration. Certainly in my constituency, both the competing parties took great pains to point out how they had “saved” the local hospital.
Whatever else may be said about the shifting, or not so shifting, loyalties of the British electorate, there seems to remain a strong emotional attachment to the NHS. Play that card well, and you’re half-way there…
The BMJ have a series of articles about neuraminidase inhibitors or Tamiflu and Relenza or panic-purchased anti-virals. For in at risk groups they reduce the duration of symptoms by between 0.5 and 2 days as opposed to between 0.5 and 1.5 days for healthy adults (not that much difference in my opinion). And yet this HTA assessment does distinguish between groups and says they are cost effective. NICE guidance recommended these drugs as options and ‘said that its recommendations about oseltamivir and zanamivir should not reduce efforts to give vaccination (also called the flu jab) to people for whom it is recommended in national guidelines’ so the government hand that feeds is not bitten.
Antidepressents have also come under fire although here it is less about political action before evidence and more the increasing effectiveness of the placebo. Recently the UK Government’s Science and Technology committee evidence check on homeopathy discussed the placebo effect and the ethics of giving placebo as a medicine…