1. A Survey of Managers About Patient Attitudes Brought to you jointly by nhsManagers.network and www.nhsmanagers.netwww.akumen.co.uk

2. The Survey About 100 senior to middle managers: clinical and functional; acute and community; NHS and voluntary sector; general managers and specialist managers … … were recently asked the following two questions:

3. The Questions 1.Why do patients put up with poor service standards in hospital that they would not accept in a restaurant or hotel? 2.Why do people who are independently minded become deferential when they are a patient?

4. The 218 Answers There was a rich variety of responses from all the participants. Literally hundreds of ideas and thoughts Answers were all in free text – the questions were, after all, very open ended. Answers such as … NHS is process driven and people tend to comply Culture, history and expectations Fear Feel vulnerable Carers feel just as disempowered/ frustrated Don’t want to be in the way

5. So What? Normally it would be very difficult to analyse and make sense of all of these answers. But working with our partners Akumen, who have some great tools, we have come up with a pretty clear picture of what people were saying. Read on …

6. 218 Rich Qualitative Answers 17 Themes Largest cluster- patients feel too vulnerable to complain! "In hospital you are worried, feeling ill and particularly vulnerable as you are worried that you might get branded as a complainer and get even worse service.”

7. Insight Map Shows The Relationship Between Clusters, What Leads To What.

8. The red arrows looped at the centre of the diagram represent a vicious circle. Patients are disempowered, this leads to apathy, apathy leads to no change and no change leads to disempowerment; closing the loop and creating a vicious circle! The biggest cluster by far was that managers thought patients felt vulnerable if they complained or challenged the NHS & its staff. The most significant chain is in blue, patients are afraid to challenge the Dr, who knows best. They simply don't have the knowledge to question, so become disengaged! The green chain says we have low expectations and we are grateful for the NHS as it is

9. NHS Staff believe the patients fear complaining or even voicing their views

10. What does this tell us? This survey goes some way to explain the relative popularity of web sites like Patient Opinion or NHS Choices, where patients feel safer to voice their opinion and it is very easy to do. However this only provides a partial solution to the “vulnerability Issue”. The most important thing is to break the vicious circle. That means we have to find ways to empower patients, help them to feel less vulnerable, help them and their families to challenge the professionals constructively. Here are some thoughts: If the NHS engages, listens and does nothing to change, the situation gets worse The NHS must identify and define why it is so change averse and do something about it Change must happen close to the complaint/comment – to close the improvement loop There is a need to celebrate change and feed back to patients The patient has to be better informed and knowledgeable about their healthcare choices What do you think? What can we do to bring about these changes? Tell us in the Forum Would this kind of survey be useful on a regular basis, a national Staff Opinion, like Patient Opinion? Let us know what you think, in the Forum or by email. brian.aird@nhsmanagers.net