Daniel Goodwin

A public service case study

I would like to tell a story about public service. My organisation has done very well in anticipating budget reductions and planning for the future, but there are still some major challenges and the next stage will involve thinking hard about productivity and good customer service. I am therefore very sensitive to how other parts of the public sector are doing and what we might learn from them. This is a story about a health interaction, but it has resonance for my own organisation.

A few weeks ago, feeling suddenly very unwell at the weekend I attended a minor injuries unit in a hospital. The service was excellent I went away reassured that I would soon be well and indeed I was. The process involved me giving my name and address, based upon my postcode.

A few days ago I received a letter from my GP surgery saying that I as I had moved I was no longer in its area and would need to register with a different GP. It gave no reason why it was assuming this, no real clue as to how to respond, no email address to respond to, or indeed the best way of finding another GP, but it did say that they would continue to care for me for 28 days and that they would send my notes to an organisation with a six letter acronym that I had never heard of. I wrote to the surgery, copying the PCT complaints department, asking for an explanation as to what was happening. They did their best to contact me and on the fourth attempt they succeeded.

I explained to the surgery reception that I had not moved. They said that I must have done because the hospital had sent a notification of a different address (which just happened to be my apartment number and my street name, but not the apartment name). I would therefore need to come in to sign a form ‘to get my notes back’. The person was polite but firm, I was not amused. However, whilst I had said to them they would need to resolve this, I decided to go to the surgery to sort it out rather than have the uncertainty.

I visited the surgery and another, extremely effective and efficient, receptionist helped me, asking me first if I had been requested to bring proof of the address. I had not, however without breaching any confidences she had a look at the record and could see that the hospital had indeed sent a letter. It had exactly the same postcode, street name and apartment number, the only difference was that the apartment name was missing. She was very apologetic and said that there was no need to bring proof of address, but that I would unfortunately have to re-register so that they could get my notes back. She also re-confirmed my email address and my mobile number.

Whilst waiting I noticed a ‘to all patients’ notice, which explained that the NHS is a professional, not a service organisation, that sometimes people have to be told things they don’t like and that aggressive behaviour towards staff would not be tolerated. I guess this was a sort of charter.

The above exchange involved a huge amount of waste. It was caused initially by the hospital failing to transmit the whole address to the surgery. However because there was no simple check done the rest of the exchange was completely avoidable, as follows:

  • The initial letter from the surgery could have asked me if I had moved, rather than assuming that I had, it could have given me indications of the next steps and an email address to respond to. Estimated cost of waste £20
  • My letter to the surgery should have precipitated a check on the facts, rather than a defence of the position. Estimated cost of waste: £20 Cost of my time to read, consider and write letters: £50
  • The three abortive phone calls could have been avoided if email had been used. Estimated cost of waste £15
  • I did not need to visit the surgery for the check that was eventually made to occur. Estimated cost of surgery time: £20. Cost of my time: £100
  • If all this had been checked I would not have needed to fill out my replacement GP form, which will now be data entered by a clerk, wasting even more time. Estimated cost of waste: £30
  • The surgery could have waited to send my notes back, whereas now they have spent time sending my notes to the SHA, will be involving the SHA staff in finding my notes and sending them back. Estimated cost of waste: £50
  • Had the initial stages been addressed properly I would not have involved the PCT, but I did so because someone less able to get round the system would have been entirely and unnecessarily bemused. Estimated cost of complaint registration etc: £50
  • This experience and the aggressive patients notice has now completely changed my perception of the surgery and I am considering whether I will continue with it in any case.
  • The total cost of this one service failure to the public purse by my estimation is around £200, or £350 if you include the cost of my time. £200 would be generated by the tax from an average person working for around ten days.

I am very supportive of public service and the NHS. Every interaction I had was reasonably good quality and all the staff were polite. One was exceptionally good, the receptionist when I visited the surgery, because she took ownership of the issue and addressed it sensibly.

I know from the complaints that I receive about my organisation that we have similar examples where stopping and thinking about the best outcome would be the best and cheapest course of action. This is not a rare phenomenon and I’ll be using this experience as a case study with my team in the coming weeks. Through it I will show that great customer service is an amalgam of good treatment of the customer in the interaction itself underpinned by common sense processes.


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This entry was posted on June 28, 2011 by in Public Value.
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