Patient Opinion's team blog

This is our NHS...let's make it better!

 Good post on the always-interesting Puffbox blog. Seems that Tom Watson the (only?) web-savvy member of the government, suggested the folks at direct.gov develop an instant site where parents could find out whether their school was closed by the snow.

The call went out last Friday – and  lo! The site was up and running 28 hours later thanks to some great work by the direct.gov team. Eat your heart out Connecting for Health.

And then a second snow flake drifts by: NESTA are organising The Lab – ‘to give people the freedom, the capital and the expertise to help them undertake radical experiments.’ Especially at a time when there is no money and economics isn’t normal any more.  So what could we come up in health…. If we had a big wand and some money, how would we at Patient Opinion contribute more snowflakes to the blizzard of innovation that we need to do old things better or new things wonderfully? Well, first off, we might sprinkle some snow flakes over the NHS  complaints procedure. Universally agreed to be miserable it desperately needs a fairy Godmother. So why not steal some of the great ideas developed within the criminal justice system around restorative justice and develop a system of restorative redress within health care? We’re itching to build an on-line complaints system built on compassion not defensiveness. And, because it would be based round the Patient Opinion platform, it might even be scalable and cheaper.  We’d also like to develop a General Public Service Improvement Licence. The General Public Licence (GPL)  holds open-source programming communities together so our proposed  GPSIL (although we must think of a snappier acronym) would do the same for public services. By providing a coherent and agreed set of values embedded in a simple licence it could release the creativity of patients, carers, staff,  consultants and service users. Especially when allied to the emerging set of on-line tools. A Creative Commons licence for improving public services.  So any Fairy Godmothers wanting to help you know how to get in touch....  

 

   

Public service narrow-casting?

In among all the hubbub about Ofcom, public service broadcasting and the future of Channel 4, who would have thought that Patient Opinion would get a mention? What a surprise!

And it's true - already we've had some very valuable help from the folks at 4ip, so far focused on getting the basics of the site right - search engine optimisation (Googliness, you might say) and usability. We're learning lots of good stuff which will soon turn itself into a better site.

But being mentioned in the context of public service broadcasting made me ponder. Patient Opinion is a digital publisher, and doesn't aspire to broadcasting. While we like to think we provide a public service, we also provide a service about a public service - the NHS. And, am I'm sure Paul must have said before somewhere in this blog, although we are looking for an audience, we're not looking for one in quite the same way as BBC online or CNN or anyone else.

For each posting on Patient Opinion, we're looking for a narrow, well-defined audience: those particular people - maybe the NHS manager, clincian or patient activist - who can take a story about their local health service and do something practical and positive with it. This isn't public service broadcasting, it's public service improvement. And we love it.


Hits and clicks are the steroids of the web. Got ‘em and you’ve got growth, revenue and eyeballs. Without ‘em your dead in the water – or at least that’s the conventional wisdom. But whose interest do clicks and hits really serve? Well sometimes it’s useful to know that lots of other people liked an item – it’s a great way to get a sense of a field that you know nothing about. But thereafter hits and clicks mostly serve advertisers and shareholders. They are important because they reflect the ability of the site to raise revenue. But what if your site isn’t interested in selling things? What if you’re site is about changing the world?

Of course if your site is about campaigning or growing a political movement, then getting the message out is important and size still matters. But there is a new game in town, sites that are about generating hyper-local change. Patient Opinion for example is about making ward 15 in Solihull General less noisy at night, or about working with staff at Rotherham to improve how relatives are cared for. Here the motivation comes from the citizen - people are often strongly motivated to stop others going through some particular aspect of  care that has been poorly delivered at some specific site in the NHS.

No point in thinking that this posting will or should garner thousands of hits. What is much more important than size is that just the right 3 or 5 or 15 people who can do something practical about the problem see it and act on it. If we could find a currency and a business model that drove such micro changes, then we would be looking at a way to release the energies of citizens to improve the world in hundreds or thousands of small but significant ways. We might also be looking at the next YouTube. 

Four economic aspects of the web make such a system possible: cheap voice enables everyone to have a public say; RSS feeds increase the signal to noise ratio and enable your message to get to just the right people; the web makes it easy to find ‘people like me’ cheaply and quickly – people who are driven by the same passion or problems as your self; and finally the web makes it easy for people to coordinate action from email to PledgeBank to MeetUp new tools are helping people get organised.  All these tools are currently citizen-centric not organisation centric. For the first time in history it’s easier and cheaper for citizens to put together an effective response than it is for organisations. The problem is that such citizen campaigns can undermine collective solidarity. Such effects can be seen with both Al Quada and the ability of particular patient groups to (understandably) pursue their own with the effect of reducing benefits to others.

So what we need are tools and a web currency that rewards citizens for their efforts and passion about some hyper-local aspect of a service whilst incentivising busy staff so that they no longer see patient comments as blemishes but as the starting point for getting professional and organisational rewards.

Hyper-local tools are what Patient Opinion is now working on. How can we exploit the new economics of the web to enable citizens and front line staff to change thousands of micro-aspects of care?


Who Cares?

We had a great day in Rotherham. Fifty staff plus a bunch of great actors from Dead Earnest and some patients - all exploring just how hard it can be to care amidst the pressures of ward and home life. (Take a look at the monologues to get an idea of the kind of stuff we discussed).   For Patient Opinion we wanted to explore ways to extend the impact of the event. How can we use the site to gently nudge busy staff into actually changing the way they care? So at the end of the day we asked everyone to make a Promise to Self – something that they wanted to do for themselves, a change in their practice that came from their professional heart, not from targets, or performance management or anything that was externally motivated. And we’ll be posting these up on the site over the next week or so. All this made me think about what ‘caring’ means. The best definition that I’ve ever found is from Val Isles: caring is always about acts of work or courage. No work or courage, then no ‘care’. So if what you’re doing is routine, or humdrum, or going through the motions, if it does not connect and challenge your professional heart to think and act, then it isn’t caring. Of course this is a particular definition of ‘work’ but its useful because only the person doing the caring can judge whether they really have been working (in this sense) or whether they have been called out of their comfort zone and acted with courage – or not. From a management perspective this is useless of course – a definition with no external measures, and entirely subjective. From the professional’s point of view seing  care as acts of work and courage is a home coming, a return to that place where the best professional practice has always existed, an internal demand to do justice to the suffering, needs and healing of another. This professional side of the story has been underplayed over the last 15 years as health service have rightly concentrated on getting the systematic aspects of care right. But ask any patient – or read hundreds of postings on the site – and you’ll soon find that in addition to providing care that is great in a systematic way (evidence-based, best practice), what people long to give and get, is ‘care’ – acts of work and courage that connect with the heart and cannot be faked.

Finding ways to combine these two aspects of great health care, the highly personal and the highly systematic, is the task of health professionals in the 21st century.

Click here if you want to see an example of a story brim full with acts fo work and courage - or here for one that fails on almost every count.