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Patient experience is more important than staff satisfaction


Involving NHS ‘customers’ at every step of the decision-making process can leave a legacy of true patient-centred care, says Joan Saddler. Leave a comment on on this story to contribute to a national debate on the future of NHS leadership

A recent report published by Aston Business School found what many of us would expect - that the experiences of NHS staff and patients are closely linked.

As consumers, we know that when we buy a product or service, the attitude and behaviour of staff as well as our overall experience influence how satisfied we feel.

In the NHS, where a close working relationship between clinician and patient is vital, the association between patient and staff experience is likely to be all the more important.

However, while NHS managers should pay close attention to staff experience, it is more important to pay attention to the patient. Although care delivered by the NHS has always focused on the patient, their needs have sometimes been assumed and the powerful role their views can play in improving services has often been overlooked.

This does not mean we have not been collecting information on “experience”.

For years, feedback has been collected via face to face interactions, surveys, focus groups, public consultations and a host of other mechanisms.

However, the NHS has only recently started to understand the need to be smarter about how we use this invaluable information. Do we always understand what matters to patients? If the answer is yes, do we always act upon this information?

In recent years, some critical measures have been introduced to help reshape the relationship between patients and services. The NHS constitution clarifies what patients should expect from the NHS. Hospitals should already be using real time feedback from patients to inform improvements and, from April, their income will be directly linked to patient satisfaction.

There have been examples of innovation. For example, some trusts use electronic surveys on wards to get instant feedback on issues such as privacy and staff attitude.

This is just one example of the drive to give patients more control and a greater say over care, and for those providing services to understand what matters to patients
and to use this insight to drive up quality.

‘Do we always understand what matters to patients? If the answer is yes, do we always act upon this?’

Across England there are managers who, by changing the way they work to better understand both patients and staff, are finding new ways to improve their services
and people’s experiences of them.

However, we need to do more - and faster. In difficult economic times, the NHS will have to make even more of its resources. We must find new ways to drive
up both productivity and quality. We will have to make what will be often difficult decisions about funding priorities. None of this can be achieved effectively without
understanding what matters to patients.

The Department of Health has launched an initiative to help services make better use of patient experience information by putting systems in place to gather, interpret and act upon data. We are also helping to spread the word, enabling managers to learn from colleagues who are leading the way.

However, this will not be enough by itself. Last year, the DH, in partnership with patients, NHS staff and the voluntary sector, produced Putting People at the Heart of Care, a vision for patient experience and engagement in health. It makes it clear that the NHS must learn to take a more comprehensive approach to engaging patients in decisions.

The patient, our customer, should drive the design and delivery of care.

For this to happen, all NHS staff - from the boardroom to the front line - need to engage patients and the public every day in making decisions. Only then will we make patients’ experiences really count.

Joan Saddler is the director of patient and public affairs, Department of Health

The Department of Health and the National Leadership council want your views on how the NHS should be managed. You can contribute to the debate by posting a comment below


Readers' comments (12)

  • As long as we perceive health as a product or service, we will struggle to satisfy patients. In my view, this is not a commodity, but a human right as education.
    The WHO Constitution states: "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being..."

    Leaders, especially those in the NHS or DH are not in a position to speak out on behalf of patients about quality of care because there are tied with the political forces.

    In the Economist Intelligence Unit ‘Doing more with less’, Professor Maynard states: “the quality issues are really quite significant because if you start to cut people’s pay, you may affect motivation and affect treatment.” (2010, p.16)

    So based on the above, let’s try humbly a syllogism.

    All happy patients are linked to happy Nurses;
    The government is responsible for pay rise, nurse to patient staffing ratio and education;
    Therefore, the government is responsible for patient satisfaction.

    Abel Sidhoum (RN)

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  • just another one of those unrealistic piece of trash advice from someone who hides in the office up in the tower of babel. lady come out and play. i think this is just to justify her oversized pay packet and maybe she got a good chunk of the nhs budget as bonus for coming up with this garbage

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  • Hi Rajnish,

    I am impressed with your post for two things:

    1. the sharpness of your writing;
    2. you are courageous because many with the same type of writing as yours would have been anonymous.

    I must add that I fully understand and respect the choice of writers who prefer to stay anonymous because retaliation from some bureaucrats in the NHS or government agencies against Nurses who wish to express their views is a probability that cannot be taken lightly.

    So keep telling your stories, your thoughts and your anger and keep protecting yourself, should you feel necessary!

    It is incredible how bureaucrats can be out of touch. Do they really enhance the quality of the debate? No, they do not because what they know best is:

    o To repeat the same emptiness all over again without knowing such as ‘use this insight to drive up quality’; if someone can tell me what it means, well done!
    o To oppose people such as Patients versus Nurses; I do not know if you notice, but politicians and bureaucrats when they loose ground they start opposing people to win their cause. What the hell! Do they think that a Nurse is not concerned about her/his Patients? Do they think that a Nurse is some sort of robot that would never be a Patient one day? Do they think that Nurses have never told them about their unsafe work conditions and the risks of harm to Patients as a result? Do they think that they can sincerely lecture or patronize health professionals about what they do best? Have they ever tried to challenge the status quo of their establishment, as to achieve patient satisfaction and safety?

    If the Government want the NHS to keep running towards quality of care, you’d better resolve the following equation:
    o Life expectancy, life-style related illness, shortage of health professionals and Healthcare spending are increasing;
    o Hospital beds are decreasing.

    The health reform has already started with the excuse of recession. It would be amplified after the General Election at the expense of quality care and patient safety.
    The healthcare system may collapse unless they reverse the reverse via smart health investments and better use of resources.

    The General Election is an opportunity for the 500.000 Nurses to stop this calamity, express their views and protect the public.

    Abel Sidhoum (RN)

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  • Roger Rowett

    Very interesting and 'explosive' debate. From my point of view the two are inextricably intertwined. Whilst it is possible to have one without the other there is no doubt (in my mind) that happy staff contribute to happy patients.

    One of the problems (across all services) with current management practice is the focus on identifying problems and trying to 'fix' them. If, for example, a patient satisfaction survey was conducted - 20% thought the service was excellent, 60% thought it was good, and 20% thought it was poor - what would 'we' do? Without doubt in most cases managers would focus on the 20% of concerns and attempt to fix them.

    Now whilst some problems will need fixing, a much more productive and ultimately successful approach is to find out why some people received an excellent service and build on this. One model for doing this is called Appreciative Inquiry - a highly successful and proven approach that results in positive and sustainable change.

    As long as we keep focusing on the problems all we will get is low moral and a blame culture. What we focus on becomes our reality!

    Roger Rowett

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  • What a load of typical management speak crap!!! (Read it carefully and you will see that in typical politician style they manage to use every buzz word without setting out concrete plans)!

    First of all, our patients are not customers, or consumers, they are PATIENTS!!!!!! They are sick and injured, they come to us, we heal them and send them on their way. Hopefully they will have a positive experience (as much as one can when undergoing treatment for cancer or having surgery etc) in a nice area, but is that really the primary concern? No!

    The NHS must not be allowed to be run as a buisness any longer, this is not a bloody shop were consumers buy goods, nor is it a hotel, the NHS is responsible for healing and health, plain and simple!

    And the one way to ensure that safe, competent and excellent clinical judgements and skills are available for patients is to ensure that the STAFF are happy!!!! Doing that and the patient will also see doctors and nurses who are happier, less tired, less burned out, with more time to treat them individually.

    Or do theses idiots still think that the fact we may save someones life is less important than the fact that they weren't happy because they didn't have a private room with a big screen?

    Yes in an ideal world we would have both, but grow up and get your priorities right!

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  • Call me old-fashioned but I hate calling patients "customers". If you are unlucky enough to be admitted to hospital then there is something wrong with your health and that means you are a patient who requires treatment from a doctor, and care, sympathy, empathy etc from a nurse. The reason we become nurses is because fundamentaly we are caring people and don't really need to be told how to "provide a better service for our customers", we just need to be supported in our efforts to care for patients in a way we would want our own family to be cared for. This would include making sure staff feel valued, ensuring wards are adequately staffed with a good skill mix. If this is done then morale is high, staff are happy and therefore patients get cared for well. The sytem falls down, not because nurses have suddenly become uncaring but because the NHS has sucked the spirit out of them, overworking them and then blaming them when things go wrong. It is very easy to sit in your ivory tower, shuffling numbers and statistics when really most managers have no clue as to how a hospital really runs.

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  • I don't agree with anything said in this article. The premise that patients or 'customers' should be driving the design of the NHS is absurd. Of course people should be having an input and there needs to be more effective mechanisms and training for members of the public to be listened to, respected and heard but to suggest what you do above is ridiculous and non-workable unless you want to run the place like Tesco's. It also demeans the training and knowledge of those who know healthcare. It reminds me of the fundamental difference between electing politicians to make intelligent (!), informed decisions on our behalf as opposed to representing mob rule.
    If you are serious, DoH, in providing a better delivery of care for the people of this nation then you damn well start funding it properly

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  • ....and if you want to actually face the actual reality of illness, injurythe impact of your policies at the coalface, rather than receiving some mealy mouthed report from a 'commission', then you need to get your shiny backsides down to the floor and have the courage and respect to meet your staff.

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  • IF we can please patients doubly by offering them extra cups of tea or more pillows then that is good - low cost customer service solutions (with the extra funding to make them happen) can only be a bonus...

    BUT you cannot prioritise window dressing over patient safety - and this is the cause of so much staff dissatisfation. We are professionals who want to do our job well and be able to protect our registration - we are not fussing over the details, these are very real concerns that are causing staff distress.

    WHEN (ha ha) the NHS manages to resolve these issues, then it will be the time to re-issue the advice in the above article...

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  • Latterlife Midwife

    What Mike said (19-Mar-2010 12:33 pm).

    Especially his last sentence.


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