Page last updated at 05:51 GMT, Wednesday, 12 November 2008

Time to pass the patient the crown?

Sir Liam Donaldson
Professor Sir Liam Donaldson
Chief Medical Officer for England

John Lewis department store
Does the way stores like John Lewis are run contain lessons for the NHS?

The BBC News website is launching a weekly column where leading clinicians and experts outline their views on health topics.

In the first, "Scrubbing Up", England's Chief Medical Officer Professor Sir Liam Donaldson explains why he believes the NHS could learn some lessons in customer care.

Read a selection of your comments

Mercy Health Systems, a hospital in the US, serves patients the barium for their stomach X-rays in goblets on silver trays, rather than asking them to drink from a traditional plastic medicine cup.

Is this a superficial gimmick or a genuine attempt to mitigate the de-humanising aspects of being a patient?

The core goal of all health care systems in the developed world, including our own NHS, is to provide high quality care, not just sometimes but every time.

Patients should not be expected to take the condescending remark or the petty humiliation in their stride
Sir Liam Donaldson, CMO for England

Those planning the delivery of health care, spend a great deal of time on the meaning of high quality care. Particular attention is given to trying to understand what it takes for a health service to be genuinely patient-centred.

Over the years, many doctors and nurses have bridled at patients being viewed as their customers.

Somehow, the term "customer" conjured up for them an image of the supermarket checkout queue or the television advert for breakfast cereal. Possibly patients themselves may not equate their needs with those of a 'customer'.

Yet, in a modern consumer society, people are bound to make comparisons.


Last year a friend of mine had an appointment with her doctor. Her local bus route was disrupted by road works. So, she left half an hour before she really needed to so as to make sure she got to the surgery on time.

As it turned out, there were no delays so she went to the reception desk prior to intending to sit down with a magazine to await her turn to see the doctor.

When the receptionist spoke to her, this was her loud greeting: "You're early. You don't expect to be seen early do you?"

Surgeon scrubbing up

The BBC News website is launching the "Scrubbing Up" weekly column, where leading clinicians and experts give their perspectives on issues in health
Each week, you will be able to have your say

In front of a waiting room full of strangers, my friend told me that she felt embarrassed and belittled.

In a health service that treats thousands of serious illnesses every day and has been a foundation stone of our society for 60 years, this was no life or death matter.

Yet, it is highly unlikely that a member of staff in a store such as John Lewis would address someone in this way. The people served there are customers. The people served by the NHS are patients.

Patients should not be expected to take the condescending remark or the petty humiliation in their stride.

And it shouldn't be the quid pro quo for the level of universal health coverage provided by the NHS, and that can only be dreamed of by over 40 million uninsured Americans.

Patients deserve a similar level of customer service to the best of any sector.

'Little things are important'

These are issues that must be debated in a 21st century health service, like the NHS, where there is no true profit and loss.

The NHS Next Stage Review led by surgeon and health minister Lord Darzi, and published this summer, has ignited this debate.

For Lord Darzi has not just said that quality of care is important, he has said that it must be the organising principle of the NHS. In this goal he surely has the support of the majority of doctors, nurses and other NHS staff.

The old cliché of the retail sector "the customer is king" perhaps has a resonance for modern health care

High quality means faster treatment, even more accurate diagnoses, better survival rates from life-threatening conditions, higher quality of life for people with chronic conditions and safer care.

However, it also means striving for a consistently good patient experience. What may have been seen as the 'little things' in the past will also be part of the big picture of an all-round high quality NHS.

A few years ago, many at the top of the NHS cast envious glances at a billboard put up by one of the private health care providers in this country. "Why didn't we think of that?" they asked.

The poster showed two figures in a hospital setting with the caption "The patient will see you now, doctor."

Simple? Simplistic? Threatening to the status quo? Or a metaphor for the empowerment of their patients that all good health services, public or private, should be striving for?

The old cliché of the retail sector "the customer is king" perhaps has a resonance for modern health care.

Perhaps the time has come for the patient to wear the crown.

Read a selection of your comments on this column

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