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Planet Rachael: when is a service a good one and how can you tell?

Wendy Johnson wants to know how you tell the difference from good quality and bad quality care, and what it means to her daughter Rachael who has autism

Today I pose a question: in terms of your service what does a ‘good service provider’ look like and how do you tell?


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You will know that patient satisfaction is an important indicator of quality care, but what does ‘satisfied’ really mean? I would hazard a guess quality in your service is measured through patients' experiences, such as feedback questionnaires, or through patient outcome measures such as referral to treatment times, or other types of targets. I would also guess that this gives you zero information about what you need to know and what matters to your service users.

This was brought home to me when Rachael attended a clinic to have a minor procedure. If you measure her experience through our usual mechanisms it looked like this: appointment letter received (before the appointment date) – tick, pre-op checklist completed – tick, operation undertaken – tick, medication and post-operation information issued – tick.

Clearer picture

So far, so terrible. Look deeper into the same scenario and this is what really happened.

Appointment letter is sent in a language Rachael didn’t understand, so was ignored until picked up by her carer. Attended the day service whose policy is for everyone to turn up at 8am, meaning an increasingly distressed Rachael waited six hours for treatment, something that resulted in a prescription for avoidable sedation. Medication dispensed without explanation of use and a post-op leaflet issued written in an inaccessible way. Staff were kind, but spoke to me, not her, and her hospital passport gathered dust.

The important point here is that nothing about what needed to be different would cost that much money. It would just take a service to ask the right questions, to the right people, and have the courage to act. Feeling brave today?


About the author

Wendy Johnson is head of safeguarding adults at risk and head of mental health and nursing lead for learning disabilities at Great Western Hospital NHS Foundation Trust and writes about life with her daughter Rachael, who has autism

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