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December 17, 2006

News from the Cutting Edge

Catalytic social innovations can change the world.

Having arrived at A&E ...waited for nearly 11 minutes before anyone arrived at the reception desk.This was at approx 6 O'Clock in the morning on a Saturday.The whole place looked deserted and like the aftermath of a football match with litter every where in the waiting area. The room that we were put in ...still had traces of blood on the floor and the bed frame.the ladies toilets were filthy with soiled paper blood etc...The nurse that came to check blood pressure etc. was very off hand and abrupt...

“Why should we pay you to provide a website where patients can just slag us off in public?” Director of Nursing, Acute Hospital

An understandable reaction perhaps given the nature of comments like the one above. But the real point here is the potential learning that such feedback creates for the organisation - not to mention future patients and commissioners.
Some change is incremental and can be accommodated easily with existing business practices. Other innovations are disruptive and make players uncomfortable.
Patient Opinion – and many other web 2.0 businesses – clearly has the potential to be disruptive. Managing this and ensuring that the overall impact is positive for society, patients and the NHS, whilst surviving as a business makes for an exciting ride.
Which makes an article in this months Harvard Business review by Clayton Christensen (who wrote the definitive book about Disruptive Innovations)particularly relevant. This time he is not talking about the effects of disruptive innovation in business but the ability of to generate better ways of solving social problems through social enterprises. What is it about The Big Issue, or micro-lending, or the Fair trade movement that makes them capable of changing society where welfare state interventions fail and businesses see no commercial opportunity?
Classically there have been two kinds of innovation: sustaining innovations (a better way to make widgets) and disruptive innovations (something that makes widgets obsolete). To this he adds catalytic innovations – innovations that put widgets to completely new uses in order to meet a social need.
Catalytic Innovations have five qualities:
• They create systemic social change through scaling and replication. This means they are not just one-off projects but that the mechanisms and resources to solve very large-scale problems are hard wired into them.
• They meet a need that is over served (because the service offered is more complex than people want) or not served at all.
• They typically offer ‘good enough’ services that are often of lower quality but which are more accessible and replicable.
• They generate resources in ways that are unavailable or unattractive to incumbents
• They are ignored or disparaged by existing players who find the new business model unprofitable or unattractive.
Interestingly Patient Opinion fits all these criteria. Our web-based structure meant that we always knew that we could scale. Indeed it is hard to think of any reasons why we would not want to be a national platform. And our subscription model creates the resources to support rapid growth.
Current systems for involving the public are both more complex and less effective than a web based system like Patient Opinion. Traditional ways of measuring feedback have their uses but speed, cheapness and universal cover are not amongst them.
By the same token Patient opinion offers data that is less ‘objective’ than surveys but which is never the less perceived as being ‘good enough’. Indeed in terms of demonstrating measurable service improvements quickly it out scores representative surveys every time.
The business model is also unattractive to incumbents: for-profits like Dr Foster find the risks of being sued unpalatable. And they are understandably uneasy about a product that sets out to make their core customers uncomfortable. It is hard for example to imagine a for-profit company publishing this kind of comment about one of its customers.
"...my father was treated appallingly in a local hospital last year ...he was left in a filthy ward, sitting in a plastic chair day and night for a month, suffered horrendous bed sores....not given adequate pain relief, not given clean drinking water,on one occasion he was left overnight in soiled pyjamas..."

All very comforting to know but does it help the business? Well yes. The article made it clearer to me that in many ways what we are selling to hospitals is a new and catalytic way of interacting with patients. As a provider you can choose not to reply to critical comments liek the ones above. Or you can see them as a learning opportunity. Our job at Patient Opinion is not to sell feedback but a service that enables hospitals to create fast, public, visible, measurable improvements in all those micro-aspects of service that are really important to patients.
Catalytic social innovations are important because they harness new opportunities and income streams that are largely invisible or unattractive to commercial or public sector incumbents and from them create new scalable solutions to social needs. It’s good to know that Patient Opinion fits the criteria exactly.

Posted by Paul at 12:56 PM | Comments (0)

December 8, 2006

News from the Cutting Edge

Being hip on the web ain't easy for organisations
It just isn't easy for big NHS organisations that - let's face it - have been used to handling feedback on their own terms, to 'get' how to respond on the web.
This posting is pretty critical of the Hallamshire Hospital:
".. my care was very poor. The communication was very poor from many of the nurses who looked after me. I was very anxious and the poor communication made this worse.... The post operative nursing care that I recieved was virtually non-existant.I lost over 8lbs in weight, through being nil by mouth for 20hrs, and having little appetite for 4 days post operation.
So even though they do not subscribe to Patient Opinion, we offered the Trust a chance to respond and this is what they said:
"Sheffield Teaching Hospitals Foundation Trust take any concerns expressed by patients very seriously and would like to apologise for the poor experience described in this case. The Lead Nurse and Matron responsible for ward I2 are implementing a number of actions in response to the concerns raised."
This kind of response is the norm for Trusts when they first start responding on Patient Opinion - whilst the motive and the actions are sincere (I'm sure that the Trusts really is trying to improve services on the ward) the tone of the posting fails to do justice to their efforts and may not give the person who posted it, or any member of the public reading it, much confidence that anything is going to improve. It is just so easy for this organisational bureaucrat-ease not to mean anything much outside the NHS laager.
I guess what is needed is for organisations to relax a bit. Hard I know in such a litiginous age. Rather than just slouching around and being negative we tried to put together an alternative response.
"Thanks for taking the time to post on Patient Opinion. It sounds like you had a really tough stay and that at times we didn't help much! I've taken your comments to the ward meeting - what you say about patients loosing weight really struck a chord with the staff as we all know how important good nutrition is to getting better. And of course they also know just how easy it can be not to want to eat properly when you're feeling poorly. As a result they decided to ...."
Any better? Any legal reasons why a Trust couldnt respond like this?

Posted by Paul at 5:34 PM | Comments (0)

December 6, 2006

News from the Cutting Edge

Get those toilet seats right
This story is one of my favourites - a pithy paragraph about great care. And the trials and tribulations of men having to use hospital commodes that are designed for women when they are recovering from hip replacements. Which is not one of those things that features in your average patient feedback but which, when you think about it, is really important.

And although its not on the site the back story is that the staff on the ward read the comment and designed a 'top commode' parade as a result and asked the next cohort of men with hip replacements which one suited them best. And then bought that one for them! Which is fantastic - and just what the NHS (and Patient Opinion) should be able to do.
Interestingly this is just what Trevor Gay is talking about on his Simplicity blog today.

Posted by Paul at 9:42 AM | Comments (0)

So what's new?

A quick update on where we're at - apart of course from busily signing all those Christmas Cards.
The main event at the moment is that we are begining to work with patient groups. An obvious thing to do and something we should have done better long ago. We hope to be developing a whole prgoramme about how the site can help patients have more influence over commissioning (that's the process by which managers plus a few clinicians decide what health seervices they are going to buy on behalf of you and me). Sounds boring but if we can get it right it should make a real difference.
For the techies we're busy working on version 2.5 of the site - should be released in January - and thanks to Headshift and to James at PO for all the great work they are doing on it. The delights of V 2.5 include
- a redesigned public interface with more signage to help you get around better.
- and subscribers will be able to set up their data feeds (RSS feeds) so that they can look at lots of hospitals instead of just one. Or at any posting that contains say, diabetes, or cancer.
- Finally we had our first meeting of B share holders in October. B shareholders are the 20 or so people who have kindly agreed to invest £1.00 in PO and who are there to give us help, advice and support. They also hold us to account - in very nice and thoughtful ways - and make sure that we stay true to NHS values. Many thanks to them all - and if you're interested in being becoming a B shareholder and dont mind travelling to Sheffield drop me an email.

Posted by Paul at 9:22 AM | Comments (0)