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Work out what your patients think

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Use your inner detective to recognise the clues that reveal your patients’ experience

Recently I discovered I have been a detective all my life - something I hadn’t appreciated until I attended a seminar by Professor Len Berry. A business school academic, he specialises in marketing and recently turned his attention to healthcare.

So how did a business school professor release my inner detective? By explaining that in service industries, people and customers are always looking for clues. The more complex the service, the more stressed the individual and the more they look for a variety of clues (Berry et al, 2006). Since then I’ve noticed I’m always looking for clues.

Clues. They are everywhere. When I go into a cafe I consciously and subconsciously look for them. How clean is the shop? Do they serve me the right drink at the right temperature? How polite are the staff? And if I look for clues when out for a coffee, how much more must our patients look for clues from us? Professor Berry describes these clues in three different categories: functional, mechanic and humanic.

Functional clues are key to the overall experience but will not contribute to an exceptional experience as they are expected as part of the service. For example, patients expect us to have the skills and competence to deliver care; they expect us to have the training we need to carry out our roles. Functional clues are perhaps more noticeable when they are absent, as we expect them to be present.

Mechanic clues are evident by how an environment looks, smells and sounds. This can also be about the “feel” of an area. Is it busy? If so, does it look organised or chaotic? In service industries, research tells us that mechanic clues are the ones that contribute to the overall experience.

Humanic clues, however, are perhaps the most important in the context of an exceptional experience. If we move from service industries to healthcare and our own teams, it may be helpful to step back and ask ourselves a few questions about humanic clues. How do we behave towards patients? What tone of voice do we use? What kind of language do we adopt? But equally important is: how do our staff behave towards each other? Do they demonstrate mutual respect?

So many clues; we emanate them continually even if we are unaware of them. The totality of clues combine to build our patients’ perception of their overall experience of care. This creates a significant part of their narrative of care. What story will your patients build from the clues of your care today?


Erica Reid is a senior nurse at NHS Scotland, has a wide experience of frontline nursing and is a Health Foundation quality improvement fellow at the Institute for Healthcare Improvement in Boston

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