Category Archives: ROI

Applying the four tests to NHS reform…really?

Happy New Year (almost). Here’s an interesting one to be filed in the ‘NHS reform challenges’ folder…

In a recent article from GP online, we see more issue arising in the GP-led NHS conversations. First it was that there was – and is – concern as to whether GPs would have the expertise and desire to commission services. Next came the privitisation concerns. Then the centralisation/decentralisation of services concerns.  Meh, perhaps they all came about at the same time.

Anywho, it seems that Health Secretary Andrew Lansley ‘this week backed plans to centralise specialist maternity services across hospitals in Kent, with Maidstone Hospital set to lose its consultant-led service’ – even though 90% of local GPs were against it (according to a BMA poll).

There are four tests that must be applied prior to any significant reform. Any reform must:

  • Have the support of GP commissioners
  • Fully involve the public (consultation and engagement)
  • Be underpinned by clear clinical evidence
  • Consider and support patient choice. That is, ‘no decision about me, without me’ (the new mantra since the release of the White Paper).

Wow. The four tests open the floodgates for interpretation. Whilst clinical evidence is rather definitively hard-and-fast, the others are so…squishy.

Significant change

What is the definition of ‘significant change’? Isn’t that a bit subjective? Some changes greatly affect certain populations whilst others may not give a lick. I mean, I may not be concerned right now with cancer services and how they’re delivered. However, should I ever find myself a service user (knock wood), you can bet your bippie I’d have an opinion.

What’s the threshold for involving the public? Is it to include a percentage of service users in a particular area? Receive a discrete number of responses? A guesstimate of sentiment? Is engagement achieved online? Through in-person events and meetings? All of the above? Maybe that’s a toolkit that should be created.

GP support

Similarly, I find ‘support’ such a nebulous term. If we take the above 90% of GPs that are against the specialist maternity centralisation as an example, we could (incorrectly, of course) assume that the remaining 10% favour the change. Does 10% constitute support?

Health minister Anne Milton has already advised that if the changes don’t meet needs, GP commissioners can seek to redesign and commission services. Sigh. Instead of constantly changing services through centralisation/decentralisation and back again, perhaps we should first design the most efficient service for an area and keep it intact for enough time to improve and truly measure the outcomes. Take the London stroke model which is already providing real results. It took a step-by-step approach to create an integrated system that would achieve maximum ROI. Patients, the public and clinicians were all involved in the design. Implementation was phased in to ensure all sites were ready with specialised staff and facilities.  Bing, bang, boom.

Patient choice

I’ve not had personal experience with the NHS and patient choice. In the very few times I’ve visited a doctor here, I’ve simply gone to my neighbourhood GP. However, if you’re a soon-to-be mom, you may well have a strong preference in specialised maternity services.

In an ideal world, we’d all be free to use any service we wished, without geographic boundaries, and would be assured of the same high-quality, cost-efficient care.

Oh, if only. Perhaps that’s my wish for the New Year…


Making sure your social media efforts are “quality”

I entered into an interesting Twitter conversation this evening with @MarkHawker following a RT I’d posted from @EdBennett, an authority on social media (SM) in US health systems. The RT link went to a slide deck presentation discussing the ROI of social media. One of the particular points I found interesting from the slides was, “Instead of ROI, think of ROC – Return On Connections,” a point we’ve been discussing recently at Premier. In fact, our VP of IT devised a formula to better track engagement for the SM channels we’re using rather than the typical number of Twitter followers or blog page views – neither of which provide an accurate picture of reach, interest, or loyalty. Rather, his metrics include a summation and ratio of retweets, blog posts, comments, trackbacks, etc., to give a better picture not only how people are viewing our efforts, but how they’re sharing them with each other.

In any case, Mark replied with a quick note that such ROI results have not been similar in his experience in the UK. To make a long story short (though more than 140 characters), Mark and I exchanged a few e-mails. I’d provided some background on Premier and my impending move next month. He advised that he’s already working in a focus area near and dear to my heart – social media as it relates to healthcare organizations. His work in the area includes writing research papers, reviewing case studies and meeting with folks on the cause. One thing he said that caused some raised-eyebrow interest on my part was, “There’s market for social media people *if*, no offence,  it’s less American and more British i.e. focus on quality and not quantity.”

My first thought was quality, vis a vis healthcare performance. Then I realized he meant content.  Oh.


Is it truly common perception that most US organizations using social media (whether healthcare or otherwise) are using it in exactly the way that I believe to be…well, wrong..?

Lately I’ve worried that in the near future more folks are going to jump on this sinking bandwagon (wait, that didn’t make sense) and use social media as a commercial-y, one-way communication channel to tout new products. Perish the thought! That’s not the intention, in my view. Let’s inform. Let’s connect. Let’s share. But for goodness sake, let’s not talk at people. Like a friend recently said, “The people who are on all of this stuff are pretty tuned in and can sniff out garbage from a mile away.” Maybe everyone should be required to review these ten helpful little pearls on how to avoid being a “twidiot” on Twitter.

While we’re at it, let’s learn from another valuable blog post by Robert Ferguson, entitled “Is listening to patients too risky for healthcare marketers.” In it, he touts the need to begin a patient-centric insight gathering program. “Insight gathering is about listening and asking intelligent questions.” Few people really care if you’re yelling in the virtual world. (Save that for some online Speakers’ Corner.) The first step to involvement is listening.

In the super-succinct words of Maryann Kuzel of Marketing Profs, it’s really just three simple steps: Listen, Participate, and Learn.

Three words. Learn ’em, love ’em, use ’em…