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What The Doctor Ordered: Customer care has special meaning in the NHS

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It is not that long since patients were expected to be unconditionally grateful for the care they received, not to ask questions and to be suitably respectful of their care-givers. At that time, nurses offered regimented care and a suitably maternal if condescending approach to care delivery. Doctors – especially surgeons – not only behaved like god but were indeed revered as his representatives on earth

It is not that long since patients were expected to be unconditionally grateful for the care they received, not to ask questions and to be suitably respectful of their care-givers. At that time, nurses offered regimented care and a suitably maternal if condescending approach to care delivery. Doctors – especially surgeons – not only behaved like god but were indeed revered as his representatives on earth.

Much has changed in the past two to three decades, and much of it for the better.

An individualised and less judgemental approach to patients has developed. Customer care has evolved to the point where the role of healthcare teams is clearly to support and assist individual patients and their families.

However, the NHS remains a large and unwieldy organisation, knit tightly together by reams of rules, regulations and customs. It is a brave individual who will run the gauntlet of NHS red tape to achieve what is best for the patient at the centre.

Yet exactly this sort of leadership is demonstrated all the time. Nurses very commonly make appropriate judgements when it comes to dealing with all those situations that the operational policies do not address.

Examples include the way in which acutely confused, aggressive patients are handled, the lengths to which teams go to achieve comfort and dignity for terminally ill patients and the daily struggle to get patients home in a timely fashion. There are doctors who challenge protocol and established practice to deliver the best outcomes for patients.

But this is not customer care in its usual sense. The phrase has come to mean the provision of service similar to that expected of reputable commercial organisations.

‘Whatever you want, you get it’ does not yet apply in healthcare, but why not? Perhaps the so-called agency relationship applies – that is, the belief that we, as healthcare providers, know what patients need better than they do.

This kind of customer care is developing in the NHS, though. Increasingly, nurses and doctors have taken on the role of advising and empowering clients, providing guidance or an opinion when requested.

It is much more difficult to get the balance right in this, as so much is individual. Nurses play a critical role here, so shoulder a huge responsibility.

The nursing team spends so much time with patients and their relatives that they are well placed to understand those needs and help other team members meet them.

Nursing staff consequently have the opportunity to provide balanced customer care in the health service. This is, essentially, high-quality healthcare consistent with appropriate clinical standards alongside supportive, informative advocacy.


Martin Sandler is a consultant physician at Heart of England NHS Foundation Trust

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