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May 21, 2007

The new Web 2.0 conversations about health care

Conversations are the essence of healthcare. Get them right, and ill people
feel better. But in the world of public conversations — of complaint or public
consultation — it is as though NHS staff get instantly transported back to the world of the silent movie. Conversations become grey and stilted, each phrase jerking past the gimlet eye of the inner lawyer that appears like magic in the heads of professionals.

But as the ClueTrain Manifesto pointed out, a powerful new global conversation has begun: "Through the Internet, people are discovering and inventing new ways to share relevant knowledge with blinding speed. As a direct result, the conversations that we can have with patients are getting smarter—and getting smarter faster than most organisations.

In a conversation people communicate in language that is natural, open, honest, direct, funny and often shocking. Whether explaining or complaining, joking or serious, the human voice is unmistakably genuine. It can't be faked.
Most corporations and organisations, on the other hand, only know how to talk in the soothing, humourless monotone of the mission statement, marketing brochure, and your-call-is-important-to-us busy signal. In the ears of patients and public this can sound like the same old tone, same old lies, same old corporate steam roller rolling over our helpless, small, warm bodies.
But learning to speak in a human voice is not some trick, nor will corporations convince us they are human with lip service about "listening to customers." They will only sound human when they empower real human beings to speak on their behalf.

Tradition, corporate firewalls and over-zealous lawyers have all limited the ability of patients and staff to converse about services. It's going to cause real pain to tear those walls down. But come down they will because democratised voice on the net will pull them down. The result will be a new kind of conversation. And it will be the most exciting conversation organisations have ever engaged in."

To this we would add: Health workers are used to having important, serious, big conversations with patients. This should give them a big advantage in holding authentic, useful conversations on the web once they get started. All we need to do is get out of their way.

With thanks to William Heath's Ideal Gov and thanks and apologies to the original Cluetrain Manifesto

Posted by Paul at 5:35 PM

May 6, 2007

Whose data is it anyway?

Trying to improve public services has never been easy – get the boulder to the top of the hill and damn me if it isn’t half way down again as fast as you can say ‘Tony Blair’. And to make matters worse public services remain largely immune to Web 2.0 and all that it offers in terms of peer-to-peer commentaries and real-time reputation building. Like a dowager duchess the NHS sails on serenely, ordering a survey here and a focus group there to find out what ‘they’ are thinking, and never reflecting on when the creative destruction of Web 2.0 might manifest itself in the quiet back water of health care.
In part this is because citizen-donated feedback on the scale that the web makes possible is an entirely new form of data and no one really knows what to do with it. Who is best placed to generate it? How should it be fed back? How should managers respond? Is it useful? In short Whose Data Is It Anyway?
So it’s great that the Cabinet Office has asked Tom Steinberg to review how the state can best use all this new citizen-donated data.Over the 2 years that we’ve been piloting, testing and running Patient Opinion we have learnt some answers to these questions and over the next few weeks we will be sharing these with you here on the blog.
Interlacing user feedback with managerial responses at scale is new. The classic ways to ‘consult’ – surveys, focus groups, user reps etc - have evolved because they are easy for hospitals and service providers to run. But by the same token they are hard for the public to use. Which is why you don’t hear many patients asking for more surveys, please!
Conversely posting to YouTube. Flicker and blogging is easy for the public but hard for hospitals to respond to. As a manager what, exactly, am I supposed to do when someone posts a picture of a dirty toilet on a ward that I am responsible for to Flickr? Make sure it is now clean obviously (though chances are that this will have already happened). But what then? Leave well alone? Post a comment? Post a picture of the clean toilet? Get on with something more concrete? (for more on this see our recent article in Society Guardian)
So between surveys by providers that are all about ‘You and Them’ and the ego-driven world of You Tube and blogs that tend to be all about ‘Me and Mine’ there is little dialogue. Clearly what we need are new platforms that are driven by ‘Us’, that convert the collective wisdom of the many to appropriately improved services. And that prevent the apparently inexorably slide into toxic ranting that purely citizen-driven sites like You Tube are prone to.
This is where I think Patient Opinion comes is – a platform that can take comments at scale, direct it to just the right manager, and foster useful conversations about what needs to be done. We don’t try and replace the freedom of YouTube but we do try and make the offerings from patients easier for managers and staff to hear and to respond to. So that hopefully we all get better services (link to posting with Trust response on it).
Of course we are not the only ones doing this kind of thing. Dipex has been running a condition-specific service a bit like this for years. And from this summer we’ll have NHS Choices – the new NHS wunder site that is meant to be all things to all patients.
What’s important about all this is recognising that this new class of citizen-donated data demands new responses and new infrastructure. If we are going to survive the 21st century then web-mediated tools that collectivise the wisdom of the many and turn it into appropriate action will be absolutely essential. Creating these tools so that they reflect civil society as well as the commercial imperatives of current individual-centred platforms like You Tube won’t happen by accident. The toxic slide to clips of teachers with pornographic voice-overs that has already happened on Youtube will probably soon be replicated for nurses and health workers. But that does not have to be the end of the story. Create the right platform and conversations become easier not harder. Get the right people involved and services improve as a direct result of patients’ insights.

Posted by Paul at 8:03 AM | Comments (0) | TrackBack

May 4, 2007

Making sure we have a choice about voice

NHS Choices, the new DH-owned, Dr Foster-led wunder website for the NHS is due to go live this summer. Reportedly costing between £8 -15 million we are looking forward to its launch and hope that it will provide a great new resource for patients.
Amongst other offerings NHS Choices will contain a ‘Voice’ section where patients can share the story of their care at English hospitals and rank the service they have received using Amazon-type ratings. Which looks remarkably like what we do at Patient Opinion – so if imitation is the sincerest form of flattery then we’re certainly flattered!
The great unknown is whether such feedback systems are best owned and run by government, a not-for-profit social enterprise like Patient Opinion, or a for-profit private commercial business. Given that all the data generated via NHS Choices (including email address and postcode) will be owned by the state we believe that people may be wary of a government owned platform. And since the most plausible buyers of Adwords on such a site are ambulance-chasing lawyers and purveyors of therapeutic snake oil, the usual advertising-driven business model may be problematic for feedback platforms about health.
Which is why we built Patient Opinion as a not-for-profit subscription-based business in the first place. Having a viable business model based on a distributed income stream derived 30+ organisations guarantees our financial independence. We can moderate and publish postings without spin and have us a market incentive to make sure that patient feedback is actually valued by Strategic Health Authorities, Scrutiny Committees, national patient groups and other subscribers.
But maybe we’re wrong. Maybe Joe Public won’t care that the state will own his or her data and ID details. So it’s great that people will have a choice of feedback platform. We believe that they are more than capable of using each platform to get what they want. If they actually want tell the Secretary of State something or have a hot-line to the Chief Executive of the relevant Trust then they should use NHS Choices. If they value independence, a platform dedicated to patients and a service that strives to to turn their feedback into better services then they may be more inclined to log into Patient Opinion. And if they just want to share their comments locally they may be happy with either.
What’s more important than anything is that we have the debate and work out how best to use this new class of data – large volumes of web-mediated citizen feedback – for the good of civil society as well as state or commercial interests. So over the next few weeks we’ll be posting lots about these issues to the blog and will be really interested in your comments and thoughts.

Posted by Paul at 9:13 AM