Hilary Brown, Fellow at the Health Services Management Centre
A recent conversation with senior clinical commissioners and providers sparked a debate about the perennial patient complaint of car parking at NHS sites. The nature of the debate suggested a level of mild frustration that when patients are asked what matters to them, parking and hospital food top the list and not those other things that clinical commissioners and providers are expected to be talking about such as mortality and complication rates.
Car parks have become an irritant to everyone it seems, those who use them and those who hear about them. It made me wonder whether patient and public complaints about car parking were a symptom of something more deep-rooted than just the basic annoyance of trying to find a space, having the right change, and trying not to incur a higher parking fee than absolutely necessary.
Having had some personal experience recently of regular trips to a local hospital to visit an elderly relative, I have found myself complaining about car parking. And I wondered what had driven me to become so full of spleen on this issue? On the one level, it’s not the hassle of the logistics that bother me over much but what it represents. I find it deeply annoying that the car park charges increase after an hour’s stay, when visiting is an hour’s duration and one imagines that most relatives and visitors would like to take full advantage of that time to be with their loved ones. How many people go over the one hour’s charge by a few minutes only? It strikes me as cynical that the FT doesn’t have a pricing structure that reflects likely usage in a way that doesn’t set out to maximise income.
I imagine it would also be deeply annoying if the reason you incurred a higher charge was because you had had to wait far longer than you had expected for an outpatient appointment. Whether this was because the clinic was over its capacity or notes had gone missing or the Consultant was late because of an emergency elsewhere.
Perhaps many patients and members of the public complain about these seemingly mundane issues not because they are obsessed by minutiae and actively looking for something to complain about but partly because they feel so unable to control such matters.
It is certainly not because patients don’t value other measures of quality or experience. For example, previous research suggests that out of 75 aspects of hospital care in England, the dimensions patients value most highly are: patient–professional interactions, communications, and being treated as an individual (Richards and Coulter 2007). In a MORI report (2008), the key drivers of patients’ satisfaction with NHS acute trusts were; respect and dignity, the privacy to discuss treatment, pain control, a proper explanation of medicines prescribed and side-effects of treatment, in addition to clean wards and toilets. Further, it is suggested that it is not that the quality of the medical care doesn’t matter, but that studies indicate patients – especially older patients – usually take for granted that health professionals are technically knowledgeable and competent, (Bridges J, Flatley M, and Meyer J. ,2010).
Patients and members of the public may focus their comments on parking, food and cleanliness because they feel able to comment meaningfully on these aspects as they are familiar with the territory, whereas they may feel completely unqualified to judge the abilities of a healthcare practitioner. And even when they do feel they have a valid opinion, they may feel it would be bad karma to comment. Researchers have identified the phenomenon of the positivity of response bias, whereby people may provide more positive feedback during an episode of care, than they would otherwise. There are a number of reasons posited for this by academics, such as not wanting to tempt fate, a deep-rooted psychological need to remain optimistic, the inherent difficulties in talking about poor experiences, and crucially not wanting to adversely affect treatment by being seen as a trouble-maker or difficult patient, (Staniszewska and Henderson, 2004).
Complaining about car parking vents some real frustration and is a ‘safe’ thing to complain about it – after all the car park won’t be administering them or their loved ones their next intervention. It’s much easier to have a ‘difficult conversation’ about an inanimate object than the attitude of the nursing staff, the fact that a consultant never returns your calls, or the confusing and often conflicting information that you are given.
So, the next time a patient or member of the public complains about car parking, rather than switch off, this might be the very moment at which to prick up our ears and see what other concerns may be lurking beneath the surface.
Bridges J, Flatley M, Meyer J. Older people's and relatives' experiences in acute care settings: systematic review and synthesis of qualitative studies. Int J Nurs Stud 2010; 47(1):89-107.
Ipsos MORI (2008) Real Time patient feedback - information patients need and value. London. Ipsos MORI
Richards N, and Coulter A (2007). Is the NHS Becoming more Patient-centred? Trends from the National Surveys of NHS Patients in England 2002–07. Oxford: Picker Institute
Staniszewska S and Henderson L. (2004) Patients evaluations of their health care: the expression of negative evaluation and the role of adaptive strategies. Patient Education and Counselling, 55: 185-192