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Why getting inside patients’ shoes is good for staff too

Bev Fitzsimons 21 September 2016

Bev Fitzsimons reflects on a frustrating outpatient clinic and wonders why addressing problems that demoralise staff and patients aren’t a bigger priority.


I spent the afternoon at a busy out-patients’ clinic at a London teaching hospital last week: not shadowing, not working with an NHS team as is often the case. This time I was a patient. The clinical staff were lovely: courteous, thorough and cheerful. The plan of action was clear and they explained it well.  The person I felt sorry for though, was the receptionist who was bearing the brunt of the system failures that just made the clinic really hard to run.

Patients were anxious and scared

I had plenty of time to observe the running of the clinic: an hour and a half in to the clinical session, it was already running an hour and a half late. Patients were getting anxious about collecting their children, whether they’d miss their slot if they went to the bathroom, how they were going to afford the parking costs. We didn’t know what was going on. People were going to the desk and asking if they had been forgotten about.

On top of this were the usual glitches with appointments: people whose appointment letter said a different time than the hospital system; confusing written information, with appointment letters instructing the reader to “read the second page” when there was no second page. It was a hot day, and there was nowhere to get a drink of water. As staff passed through the clinic, they averted their gaze, obviously embarrassed that people were waiting so long. These “small” mistakes undermine confidence and make you worry that the more critical aspects will go wrong as well.

What sort of day was the receptionist having?

I was thinking about what sort of day that receptionist was having too. She was alone on the desk, with at times the queue backing up to the door. She was being asked the same question over and over, by anxious and sometimes cross patients. Every administrative hiccup she had to try and sort out, leaving the reception unattended and the queue ignored.

What makes me sad is that all of this would be pretty easy to sort out. Things could be so much better for patients and for the staff as well. The quality of the patients’ experience is everyone’s business. That’s why we encourage teams to understand the perspective of patients in our improvement work through observation and shadowing.

People don’t go to work in healthcare to do a poor job, but sometimes the systems seem to work against them; that gets the staff down as much as it does the patients.  Our patient-focused improvement work helps teams to identify and implement improvements which address these design failures in the system.

No second chances for patients and families

This year we have been working in partnership with NHS England to work with eight teams across the south of England, to support them to improve care of people who are at the end of life. There can be no greater priority for improvement, and there are no second chances to get it right for these patients and their families. The teams we are working with are using our patient-centred methods to get inside the shoes of patients and their families. They will be sharing their work in more detail at the King’s Fund’s “innovative approaches to end of life care” event on 22 September.

What we have learned is that the commitment to paying attention to the small things that make a big difference to patients has to come from the top, with leaders being clear that patients’ experiences matter. Once they do, we have found that the teams we work with find it motivating and energising to put themselves in patients’ shoes, and make changes to the small things that have a big impact on patients and on their own working lives too.

Back to my own experience, I’m going to be dropping a line to that particular NHS trust, inviting them to use some of our patient-centred QI methods. I hope for the sake of the staff and the patients that they do.