The Customer/Patient Journey

An indication that I have too much time on my hands is the recent discovery, while searching for some gardening information, of a website devoted to gardens and gardending, called Growson you. So, I've set up a blog there where I can blog away on gardening to my heart's content. Visit: www.growsonyou.com/kowhai

Joining such an on-line network with a shared focus demonstrates the importance of having a common interest. I've already had comments on my blogs, and, having posted a question regarding the name of a variety of hardy geranium which is an important occupant of my garden, I received half a dozen replies, one of which led me to the name. Such feedback promotes involvement, an important part of membership, and I can feel myself being sucked in. However, there is a price to membership: if you want to have people take an interest in what you re posting, you have to reciprocate. Given the number of active members in a network like Growsonyou, this could become very time consuming, so judging the amount of involvement seems to be part of the discipline of such social networking.

Meanwhile, I've had a minor set back healthwise which has led to further reflection on the customer journey, a useful concept in customer service management. About two years ago, I became aware of swelling in the lymph glands, the effect being like a mild case of mumps. Eventually, I went to my GP, who prescribed a blood test, the results of which were fine, except for one : the white blood cell count was 'elevated'. She then referred me to a haematologist at the Royal Berks Hospital (RBH), nine miles away in Reading. What I was embarking on was a very particular kind of customer journey, though I must say that I didn't think of it as such at the time.

In a customer journey, particularly in service provision, the customer may be handled by a number of different departments or sections within the organization providing the service. The danger is that, thanks to siloization, the different sections may provide widely differing standards of service, and the baton change from one section/silo to another, far from ensuring a uniformly satisfactory experience, may result in a mismanaged transition. In the kind of medical journey which I was embarking on, there are many baton change points where failure can occur, either medical failure (e.g. failure to pass on information), or service failure (e.g. helpfulness and reassurance of staff to patient).

There is, of course, a major difference between the conventional customer journey, and the journey of a patient, even within a service oriented health service. In most public services, including even privately owned and operated public transport, the 'customer' has no choice (e.g. there is only one train service from where I live), whereas in a conventional customer-provider context, the customer exercises a choice based on experience, preferences and aspirations. It is for this reason that so many providers of goods and services spend so much expertise and money on advertising to promote their offer and to persuade customers to chose them rather than a competitor. In something like the national health service, choice is extremely limited, and when it comes to the actual treatment, the patient is entirely in the hands of the medical practitioners who have responsibility for diagnosing and prescribing treatment. So, if the doctor prescribes a series of tests, the patient has no choice but to conform, or face the consequences.

It was with having a series of tests that the relevance of the customer journey became obvious. I discovered that I had become a series of test focii, and each test site involved an entirely different section within the hospital, located in different places, and each doing entirely different things. Instead of being a holistic patient, I felt that I had become an entirely separate series of things to be tested. The focus of concern at each stage was the procedure to be carried out, and although each tester may have been aware of what the purpose of their contribution was, basically, they were doing what they specialized in, and their specialization had many potential applications.

So, I moved from one silo to another, feeling like a series of medical problems, each to be given a different test/treatment, rather than a unique, individual and special customer/patient. Two of these tests involved biopsies, which are invasive, and one involved a scan, which consisted of preparation (consumption of the so-called barium meal) and being scanned in a piece of sci-fi hi tech equipment. And at regular intervals, to the extent that it became a routine, blood tests in yet another part of the hospital or, more conveniently, at my local GPs practice.

By and large, the service standards were pretty uniform across silos. But, when going to the hospital for a lymph gland biopsy, I experienced journeys within the journey, discovering that there were information gaps as well as the effects of social dynamics among the service staff. When I arrived in the recovery room following the biopsy, there appeared to be some competition among the attendants as to who was going to transport which of the three patients to their wards. In fact, what was going on was the kind of joshing among workmates which is common in any work place, but it seemed to be out of place in a recovery room (where one of the patients was still unconscious) and it wasn't clear to what extent the two conscious patients present were to be admitted as participants in this social encounter. (Basically, all I wanted was to get back to the ward as quickly as possible, so delays caused by the social activities of staff were unwelcome, but I didn't feel that displaying any signs of displeasure would speed my journey!)

The glitches and confusions that can occur in the medical journey have most recently been illustrated over the past week. On Monday I saw the haematologist for my six month post treatment check, when I was informed that my white blood cell count was lower than it should be at this stage. I was warned that, since my immune system is compromised, I must avoid getting any infections and that if I suffered from a rise in body temperature, I should come back to the hospital. Fine. Then on Friday I started a cold. Is this an infection as defined? The hospital ward which I would normally call for advice was closed by now, so on Saturday morning, I called the alternative ward which is to be referred to out of hours and weekends.

The duty nurse advised me to initiate another journey because out of hour treatment has to be dealt with by a set of sub procedures which are not actually managed by the hospital. As I discovered, this involved calling an out of hours number, subsequently talking to a doctor, who then referred me to our little local hospital, where I saw another doctor, who having confirmed that my temperature was too high, then prescribed treatment. What I didn't ask her was whether I should, on Monday, refer to the RBH and inform them. Is it important to do so? Or is it irrelevant? This is another aspect of the patient journey which differs from the non medical customer journey: judging whether doing or not doing something will jeopardise the outcomes and quality of the service.

So, the medical/patient journey has revealed some significant differences with the regular customer journey, which I feel demonstrates the limitations that need to be taken into consideration when importing private sector concepts and practices into public sector contexts and into a context, like medical treatment, where ultimately the patient isn't in the traditional customer relationship with the provider. That doesn't mean that medical services should ignore the principles involved in managing the customer journey -- achieving a uniformly high level of provision across journey stages seems to be a worthwhile goal, for instance -- nor does it mean that patients should simply meekly accept whatever is given to them, but in the end, importing ideas and practices from one context to another has to be carefully judged.