Are health services different from other services?

A recent Harvard Business Review paper (see previous blog post) on service redesign used examples from the world of health and finance alongside each other. It seemed strange to read about something a hospital somewhere was doing and then, in the next paragraph, how a multinational bank was tackling a similar problem. Are health services and financial services comparable?

If you compare the customer experience of choosing a holiday, a financial service, an energy supplier or restaurant with that of choosing a health service or treatment, you inevitably end up with someone saying “Ah, but health is different”. Nine times out of ten this is followed by “people are at their most vulnerable”. Both of these statements are true; there is an emotional overlay to situations that affect one’s health which is not usually there when considering other commodities or services. But are they true to the extent that they should prevent us thinking about the similarities with other services rather than the differences?

Roy Lilley’s spirited blog on the Kings Fund website highlights how our experience of booking flights, getting money from our banks and shopping has been transformed. Yet we are far behind in health services, only now starting to commonly use the telephone as a means for communication with patients. Many reasons are given for us being slow to let go of traditional means of face to face, one to one doctor patient contacts – patient confidentiality, clinical risk and governance and our strong sense of duty of care. All valid of course but maybe they do not need to prevent us changing the way we do things.

I am convinced that our assumption that patients are vulnerable does hold us back. There is an element, subconscious or not, of the medical profession not realising or not wanting to realise that people neither want nor need to be dependent on us. Our reluctance to move from paternalism to enablement is illustrated by the staggering statistic in the Kings Fund infographics pack that 60% of GP surgeries have the facility to allow patients to view their own records online but less than 1% currently do.

To be blunt, I sometime wonder who benefits most from the reality or myth of the special status of the doctor-patient relationship. I do not wish to offend or belittle the many, many times that a patient has benefitted from excellent care and advice in the traditional setting of a hospital ward, GP surgery or outpatient clinic. Yet I wince when I hear doctors say they are responsible for someone’s care when they or their teams have contact with them for a tiny proportion of the person’s life.

Of course some patients are vulnerable or may be temporarily in a vulnerable situation or state of mind, but our default should be that most people are perfectly capable of making decisions that are right for them and of looking after their own health or illness when they have the information they need. Our role is to get them the information that is right for them or help them find it elsewhere. If we do this for most people most of the time, then we can focus our attention on the truly ‘vulnerable’.

Even in this online world, you can still go into a travel agent to book a flight, go into a bank and see a bank manager. It is just that the norm and expectation has shifted so that these are now the exceptions not the rule.

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