I have just personally reviewed every opinion posted about NHS Highland on the Patient Opinion website. And when I say personally, I mean personally!  Patient Opinion is one new approach we are taking to encourage patients to feed back.  It forms part of our overall approach to capturing patient experience.  At a time when resouces are tighter than ever some may be tempted to reduce the time they spend on the so called "softer" elements of patient care.  But in my view it's more important than ever that we listen to our patients.

I am delighted that staff are taking it so seriously.  In response to one of our recent stories a Head of Service commented, "Thanks for sharing this with me too.  It's always good to get feedback and it helps us to make improvements that make a difference to patients.  it was great to see lots of staff being appreciated not just the Consultant!"

A patient who raised an issue on Patient Opinion about prescriptions alerted us to a problem that we have now fixed.  And having carried out a wider review we have been able to bring about improvements across Highland.

Ultimately we want to get to a position where giving and receiving feedback is as natural as saying please and thank you.  

Online tools like Patient Opinion will help us to listen, respond and improve.  I commend it to you.

Elaine Mead, Chief Executive, NHS Highland

Back in 2005 when social media was just getting going I read the Cluetrain Manifesto. It told companies in no uncertain terms about just how different the coming world of informed consumers was going to be. Cluetrain was big, famous and influential. It used this picture to illustrate the way that companies were treating their customers.

Not very Christmassy I grant you but arresting. And if you were being unkind – or had just spent too much time at the Mid Staffs inquiry – you might think that incidental roadkill is exactly how lots of people who have been harmed by the NHS end up feeling.

So our (slightly sombre) Christmas Cracker is a new version of the manifesto re-written for the NHS and updated to take account of social media. (And our thanks, acknowledgements and apologies to the great original.)

A Cluetrain Manifesto for the NHS

People using social media 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.

On the other hand when the NHS ventures on-line it usually talks in the humourless monotone of a Comms strategy, and the your-call-is-important-to-us busy signal. Same old tone, same old evasions. No wonder people are beginning to lose respect for a health service unable or unwilling to speak as they do.

But learning to speak in a human voice is not some trick. Trusts and Health Boards will not 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. This isn’t difficult – some health organisations are already doing it really well.

Twelve Propositions for the NHS in 2012

1. Social media means that the networks surrounding health services are getting smarter, more informed, more organized. Participation in these networks changes people fundamentally.
2. There are no secrets in this new world. Combine open data with democratised voice and whether the news is good or bad, everyone will know it.
3. With a billion people on Face Book the NHS’s attempts at patient engagement and empowerment look increasingly out of touch with reality.
4. The hard-to-reach aren’t 'out there' – they are alive and well and working in the NHS.
5. The NHS is having two conversations. One with itself. The other with everyone else. In most cases, neither conversation is going very well. Almost invariably, the cause of failure can be traced to obsolete notions of command and control.
6. Front-line staff - who make the wheels of the NHS turn each day - want to join these public conversations directly in their own voices, not in platitudes written by the Director of Comms.

Meanwhile what people are thinking online goes something like this:

7. The people we’d really like to talk to on-line are the nurses and doctors who look after us. But you always hide them behind a corporate smokescreen that prevents anyone taking responsibility for the words that come out of their mouths. Don’t you trust them? Or is it us you don’t trust?

8. We already know some people who work for you. They're pretty cool online. Do you have any more like that you're hiding? Can they come out and play? When we have questions we turn to each other for answers. If you didn't have such a tight rein on "your people" maybe they'd be among the people we'd turn to.

9. We’d be delighted if the NHS joined us in this new world of social media. But it's our world. Take your shoes off at the door, start talking human! Even at their worst, our on-line conversations about your services are more interesting than all that corporate flim-flam you’ve been shoving at us since Mrs Thatcher's time.

10. We've got some ideas for you too: some new tools, stuff that will make your services better, and your staff happier. For free, right now. Got a minute?  

11. We'd like it if you got what's going on here. That would be really nice. But it would be a big mistake to think we're holding our breath. We have better things to do than worry about whether you'll change in time to get all this. Health care is important but it’s only a small part of our lives. It seems to be all of yours. Think about it: who needs whom? 

12. To the NHS these networked conversations may appear confused, may sound confusing. But we are organizing faster than you. We have better tools, more new ideas, no rules to slow us down. We are waking up and linking to each other. We are watching.

But we are not waiting.                                                                                                         

                                                                                      Happy Christmas!

"In times of change the learners will inherit the earth while the knowers will find themselves beautifully equipped to deal with a world that no longer exists."- Eric Hoffer

Two fascinating stories have kept us talking at PO HQ this week, both incidentally linked by their intimate, hard-hitting honesty.

Firstly, we were struck by the story of Joy Tomkins, an 81 year old lady who has had 'Do not resuscitate' tattooed to her chest. An unusual decision, inspired by a retired nurse who did similar back in 2003, and one that undoubtedly demonstrates the conviction behind this lady's decision.

She resolutely states that she could not bear to "make beds and wash-up for another 20 years". "My mother-in-law lived to be 106 and in the last six years of her life she'd have been much better dead. She was miserable. I'm 81 and don't need any more use. What do you think I'm going to do with the frightful thought of getting to 100?"

I was quite taken by the way Joy speaks about her life, and her absolute acceptance of death. She far from wishes it upon herself, but accepts the inevitable and sounds entirely fearless. "I've had 80 good, interesting years of marriage and children and grandchildren and plenty of friends"she said. "I'm quite happy if I wake up in the morning, but if I don't I'm just as happy."

In a world obsessed with prolonging life, I find it refreshing to hear Joy speak of her appreciation for the healthy years she's had with her family and her calm and resolute approach to death.

In a similarly frank and honest way, Gail Porter spoke this week on Radio 5 about her experiences of being sectioned earlier in the year, and the residual anger she still feels. Gail was sectioned to a secure ward for 17 days, during which time she had very few visitors (at her request) and says the experience has had a profound impact on her. Gail goes on to say that on release she remembers thinking "what was that supposed to have done for me?" and for a long time resented the people who made this decision for her.

As Patient Opinion, we receive lots of stories which detail highly emotional and distressing forced admissions to inpatient care and it's always been fascinating to hear how people feel a little later down the line, at a point where they reflect upon what happened to them and how it made them feel. In that respect, Gail's story has a strong message.

She feels that secured inpatient care wasn't what she needed and that the treatment she received and separation from her family, particularly her young daughter, made her more unwell. She speaks calmly and thoughtfully about the whole experience, and I'm glad to see that she looks happy and healthy.

Gail's words got me thinking about the stories we have, and how important it is that people are supported to express their wishes, especially at the most difficult times and make the right decisions for them. Feeling empowered and confident enough to say what you feel you want and need from health care could really make all the difference.

I have just had my first experience of the NHS Scotland Event - it was a surprising couple of days!  With a load of NHS Scotland bigwigs in the same auditorium I expected to hear about the 'challenging financial climate', that we should 'do more with less', and the key would be 'improvement', 'measurement', 'productivity'...and I wasn't disappointed: they were all there with bells on!

However, 'compassion', 'care', and 'empathy' also featured prominently, perhaps even more so - what a relief!  Were there even lessons to be learned from the Disney Corporation?  Will we ever call patients 'guests'?

It shouldn't be so surprising but it was reassuring that senior health service staff and government officials are placing these fundamental values front and centre.  As so many Patient Opinion stories, convey, the absence of these values can make the difference between a good experience and a bad one, aside from any clinical intervention.

I came away remembering a quote from the film, 'Patch Adams', "treat the disease, you'll win some, you'll lose some.  Treat the person, you'll always win."

It's a great sentiment; it's been around a few years now!  However, not sure if it can quite compete with the Acting Director of NHS Scotland quoting Lady Gaga!  Apparently, the NHS is Scotland is "on the Edge of Glory"?  How exciting!