Notes from the field of public involvement

Saturday, 19 February 2005

Measure what matters - "Assessment for Improvement" Consultation

"Measure what matters" is a key phrase in the Healthcare Commission’s consultation Assessment for Improvement. To that we have to add the key question: "matters to whom?"

M-A-C's expertise is bringing the consumer/user/patient voice into any debate. Even in these days of 'customer focus', we still see how late that voice is consulted and how little it counts against established and internal voices.

One example might be instructive. In the discussion of the developmental standards dealing with public health, the section dealing with health and healthcare needs and other elements lists a variety of ways of developing that understanding. Nine ‘objective’ measures are listed. Most are statistical e.g. standardised admission rates.

At the end of the list is 'surveys of patients'. At least it is there, as is 'surveys of staff' when the discussion turns to health issues in the work force.

How should these surveys be organised? What status does the data have against the internal performance-based measures? How can an organisation like the Healthcare Commission or indeed any of the healthcare organisations involved bring these two sorts of information together, uniting fact with feeling, to create patient-focused standards? It isn’t going to happen automatically.

One of the most intractable problems in the development of the 'customer care' culture was to try and yoke disparate sources of different kinds of data together in a coherent and actionable way. The butterfly of customer data can be very hard to pin to the board – it is fragmented, changeable, difficult as mercury to catch. Reconciling the consumer perception to internal factory-line data is hard – so hard that many gave up and believed their own data. Data that gave the customer view was binned since it contradicted the hard facts. The outcome was that they spend a fortune on measuring and managing elements of their product or service that the customer did not give a hoot about. Customers are magnificently subversive when it comes to the careful plans of marketing people – one of the reasons why customer and complaint data can be so painful. I would guess customers/users are equally uninterested in or ignorant about or take completely for granted most of the Regulator’s standards – until of course something goes wrong.

Even if a management persisted, they needed a lot of learning and experience around the commissioning of cost-effective research. How do you enlist patient-based data into an evaluation of public health programmes? What is the best way to balance one type of evidence against another? The Healthcare Commission talks about 'weighting' certain sorts of data. How?

PCTs and Trusts will have to evolve running programmes of cost-effective research that are linked to the key standards and measures. They will need a lot of help and money to do this plus a lot of reassurance that the regulator will believe it and give it its correct place when it is presented. Let's hope they get the help they need.

Colin Adamson | Send feedback