- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Saturday, February 21, 2009

Patient or Customer?: Caring under a panoply of words

Through twitter I came across a blog post 'Should patients be treated as customers' at Kevin MD.

I posted a comment and this post develops the thoughts there....

There is a panoply of words we apply in the various contexts covered by health and social care. Those associated with patient are subject to ongoing debate...

I use the word 'panoply' on purpose because individuals and services can hide behind words - or jargon - as we all do, using words as a defensive shield.

Panoply struck me with its multiple meanings. As definitions reveal the word suggests an abundance of something - 'flags'! Panoply also suggests something covered. A need to protect as per the meaning applied to armour.

A friend - a retired nurse - recently had an in-patient experience that proved rather shocking in terms of the past 3-4 decades of nursing theory and practice. During this time of course the nursing literature has espoused the need for individualised nursing care. All that effort according to my friend's particular patient experience or customer journey suggest that nursing has not moved on.

Perhaps there is a perpetual policy irony (PPI?!) that sets wiser heads rocking to-and-fro: the more something is in vogue - written and talked (flagged) about - the less it really applies in reality?

Which brings me back to KevinMD's post. There is and needs to be a tension between patients as passive players in the sense of them being (allowed to be) patients; and patients as members of the public with experience to translate into service improvement and change. Patients are also citizens - taxpayers and many of whom have a desire to push up the quality and accessibility of health and social care services.

The first stumbling steps of PROMS (patient reported outcome measures) is now under way to gauge quality and outcomes.

'Patients' will tend to be viewed as 'customers' when the systems used to collect their 'satisfaction ratings' of the 'patient experience' are adapted from existing CRM applications: re-engineered - tinkered and tailored - to suit another industrial commercial niche or market sector.

This is not to be cynical, it is being realistic about the commercial realities in which health and social care is practised.

There's a dated concept in nursing theory (and medicine) patiency. When does patiency begin? When does it end? Perhaps it is time to revisit this from an informational perspective?

If the public is engaged as per the Patient Public Initiative then (idealistically) they can 'shop around' before they extend their health career reach to the mobile paramedics (strategically sited around the community) and possibly on through to A&E. Then the public has acted politically and socially prior to their need to engage in the actual care processes themselves.


Here's the post on the 'public' and the sanctity of records which includes some additional links...
(Confidential) Letter to self - and you, and you, and you... ?