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Processes, Viewpoint!

Is anyone measuring what matters to patients?

I’m writing this after a frustrating morning as a Customer (victim?) of the NHS and its processes.  How difficult can it be to design and manage a patient booking and appointment system that meets the needs of patients?  Of course, the answer must be that it’s extremely difficult.  But why?

The two issues that prompted me to ask the question “is anyone measuring what matters to patients?” were:

  • Being seen 30 minutes later than my booked appointment time (which was mid-morning and barely late enough for things to be “running late”)
  • Not being able to book a follow-up appointment for a date at the beginning of July (because “we’re not set up for that far ahead”)


I am absolutely not criticising the service provided by the Reception staff or the Doctor who I saw.  They were all helpful and delivered the services which their processes enable them to do.

My conversation with the Doctor about seeing him 30 minutes late was enlightening.  His view was that someone “upstairs” was pressurising the booking team to add extra appointments (presumably to achieve some efficiency target or productivity quota).  The hospital must have loads of data on the number and type of patients, appointments and services delivered.  It ought to be relatively simple to produce some Statistical Process Control Charts showing the normal variation in the process and its current level of capability.  You may want to remind yourself of my article on Statistical Thinking.  But, is anyone measuring the number of appointments that happen on time, the actual time required in each appointment, or patient satisfaction with the appointment and booking process?

Caseload SPC Chart

Caseload SPC Chart

My second issue about not being able to book an appointment in 3 months time was even more puzzling.     Patients will want to book appointments in July, so why can’t they do it at a time that suits them?  This reminded me of the Determinants of Service Quality Model (ServQual) which is a way of measuring what matters to customers.  It uses the RATER framework:


  • Reliability: does the supplier do what they promise?
  • Assurance: does the supplier inspire confidence?
  • Tangibles: does everything the supplier gives you, or shows you, “scream quality”?
  • Empathy: does the supplier communicate with you in the way that you want?
  • Responsiveness: does the supplier act in a timely way?

I’ve written about ServQual previously; for example, in my article: “Do you want me as a customer?

I doubt if anyone is measuring the number, or proportion, of patients who get appointments at a time that works for them, or those who are able to make the appointment booking when it suits them.  They’ll be too busy focusing on measuring patient waiting times (which may also be important) and “no shows”.  They almost certainly won’t be reading my article on Process Measurement!

As I’ve said on many occasions: “you can take great people, highly trained and well-motivated, but put them in a lousy process and the process will win every time”.  A final thought; if none of these people know how to “do improvement”, then the likelihood of them improving the performance of their processes and meeting their customers’ needs better is minimal.



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