Comment / Getting a patient perspective

Finance staff working in the NHS are no different to other NHS staff – they’ve signed up to help patients, to do their bit for a service they value highly. The HFMA staff attitudes survey has underlined this point on numerous occasions.

But it can be all too easy for us as a finance community to focus on our direct roles, whether that involves compiling budgets or reports, preparing accounts, supporting efficiency programmes or agreeing contracts. So, it was fantastic to be given the opportunity to take some time out to think specifically about the patient experience, our role in improving it and how innovation and technology can help – or hinder – the process.

The opportunity was provided by our colleagues in the US HFMA with a retreat in October looking at intelligence, innovation and the patient experience of care.

A panel session provided a useful reminder that some of the things we are currently pursuing are not necessarily that high on patients’ priority list. Electronic access to health records – being targeted by numerous health systems internationally – are a good example. Patients want to be listened to, communicated with clearly and treated with courtesy and respect – and the role of technology should be to support these goals.

We also need to be clear what we are trying to do by improving patient experience. Christina Dempsey, chief nursing officer at consultancy Press Ganey, reminded us that patient experience is not about making people happy – no-one is happy about being in hospital. It is about optimising the experience for patients and their carers. Healthcare providers need to focus on safety, quality and patient experience and also ensure that their care teams are engaged and resilient.

The aim is to recognise and alleviate suffering that is inherently part of being ill and to eliminate avoidable suffering that arises from defects in care and services. You may not be able to do much about a cancer patient losing their hair as a result of chemotherapy, but you can ensure their room is clean and that care staff take the time to engage. Much of the presentation reminded me of Dr Kate Granger’s ‘hello my name is’ campaign in the UK and the importance of human connections.

Everyone, she insisted, can have an impact on patient experience – not just nurses. Ms Dempsey had evidence that proved that there is also a financial pay back to improving patient experience – with patients having the best experience being less likely to be readmitted and to have low average length of stay.

There is a major focus across the world right now on public health and prevention. Prevention is a no brainer, but it is proving surprisingly difficult for health systems to make major progress – particularly as investment can have a long payback period and short-term demand for treatment does not reduce.

But a session from David Asch, executive director of Penn Medicine Center for Healthcare Innovation suggested that we may also need to rethink how we deliver public health messages. He argued that simply providing information was not enough to change behaviour. We know that smoking is bad for us, but some people still do it. The first step is to recognise that people can be irrational, but they are irrational in predictable ways.

He said healthcare and public health providers should recognise that people care more about outcomes today than those in the future. So, if we want to change behaviour, we need to make rewards frequent and immediate. People could be nudged in the right direction and incentives needed to be simple.

In the US, some companies (responsible for the health insurance of their employees) have piloted reward/penalty schemes to encourage healthier lifestyles. Charging employees that don’t reach a daily steps target might seem incongruous in the context of the NHS, but it is interesting to see systems exploring how the sound theory of better public health can be turned into working practice.

Farzad Mostashari, chief executive of primary care provider Aledale, picked up a theme that will resound with many managers working in the NHS. He focused on what healthcare providers could do to save the most lives (as opposed to what things people could do themselves). Technology could definitely help here – identifying patients with hypertension who had not had their blood pressure checked recently, for example, or using computers to prompt clinicians to order pneumonia vaccine. Often clinicians recognised the benefits of doing these things, but they needed to be helped to do the right thing.

Decision-support tools, often part of electronic health records, are another good example of an increasingly used support system. This is not medicine by machine, but using technology to enhance the knowledge, skills and intuition of clinicians. He also talked about how predictive algorithms can be used to help deliver better care. An example was how computers can be used to identify the days of the week and times that patients with certain characteristics were more likely to attend healthcare appointments.

Mirroring a specific challenge facing the transformation agenda in the NHS, Dr Mostashari said that current incentives in the US needed to be flipped on their head. Keeping people out of hospital has to become more profitable than having them in hospital, he argued.

The finance function doesn’t need to be told that its overarching goal is to help improve the population’s health and healthcare. However even with the right intentions, it helps to challenge our actions and try to really understand the impact from the patient’s perspective.