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Could 'customer-focus' be the forgotten tenet of quality improvement in health care? Many other industries include such a focus when putting in place improvement strategies. In health care, we seemed to have been more comfortable adopting some the aspects of the industrial model of improvement (e.g. LEAN, Six Sigma) than others. Quality improvement seems to have largely focussed on the technical aspects of care and process flow. Other industries have recognised the impact of a client focus and possibly none better than Disney. And it's not just customer focus that brings better outcomes but equally a focus on staff. In the Harvard Business Review recently, Rob Markey re-inforced the need to focus on the satisfication of staff, noting the linking of "employee engagement to customer outcomes." Interested to learn more? Join our upcoming ISQua Knowledge webinar with Bill Shannon drawing on his industry experience for valuable lessons for health care services.

It does matter what patients say about hospitals - and it goes well beyond just 'customer service'! New evidence out this week supports the link between patient feedback about hospitals and quality of clinical care (Greaves et al 2012 Arch Intern Med). Positive online recommendations by patients were associated with lower mortality and lower readmission rates. Better online patient ratings of hospital cleanliness were associated with lower rates of hospital acquired infections. USA and England have a history of online transparency. In recent weeks we have also seen 'Patient Opinion' launched in Australia. There is so much we can learn from patients as consumers of our services. We also need to support patients improving their own health by being transparent with notes recorded by doctors in medical records. See what Jan Walker has to say about Open Notes in the Meet the Author page...

My...the new year is off to a racing start! It has been an inspiring start for me in my work in patient-based care. We have developed a program at the Clinician Excellence Commission called 'REACH' which promotes patient and family activated escalation of care/rapid response in response to 'worrying concerns' about hospitalised patients. We had our first call made by a family member at a rural hospital in early January. The call was made by a patient's daughter a few days post-surgery. It was appropriate. The treatment plan was changed as a consequence. The family were delighted and have praised the program and the staff. All in all - a good outcome. Please let us know about your experience with patient and family activated rapid response? Comment here...Next highlight? ISQua Knowledge Webinar on "When Things Go Wrong..." Register now!

I was at a Roundtable recently where the discussion was about trying to get a nationally uniform approach to how we collect patient care experience survey data (in Australia, each state uses a different survey). This information is important for tracing long term trends ('keystone' data) but in many ways where things are getting interesting in the improvement field are in real time feedback systems, patients sharing experiences on websites, health services using the richness of narrative stories to drive improvement and new patient reported outcome measures (PROMs). What are your thoughts about capturing patient care experience? That's all for 2011. Thank you to everyone who contributed and especially to the ISQua Knowledge Team! ......2012?... Open Notes? Respectful management of serious events? Patients engaging in quality improvement? What would you like to talk about?

Storytelling is used by many great leaders as a motivator of change. At a forum I attended today, I was reminded of the power of patient stories for driving change in health care. 'Alice' is an inspiring woman who experienced a major incident regarding her newborn son in a transition of care between a hospital where she received maternity care and a paediatric facility. Not only did she ask 'why?' but she went on to work with health care professionals and managers to ensure that this didn't happen again. Since this incident, 'Alice' has worked alongside health care professionals at the Centre for Newborn Care to improve survival rates from 56% in 2001 to 93% in 2010 for the condition that her son was born with (Congenital Diaphragmatic Hernia). She shares her story, as painful as it is, because she wants better healthcare for all. She is clear, however, that her story is just the beginning. I am pleased to say that we are now working together to promote patients, families and carers as true partners in improving the safety and quality. To get the full picture in healthcare improvement, you need the whole story!

There is a really exciting feeling in the air. People are starting to look at what 'quality' in health care means in a different light. The fact that the 'Patient Centred Care Community' is one of the first 'cabs off the rank' for ISQua Knowledge supports the ground swell towards a view of quality that moves beyond an industrial model. I have given much consideration to what to call this community - patient-centred, patient-based, patient-focused, consumer-centred, patient- and family- centred, client-focused. I have landed on the term most frequently used in international settings to date. I don't want to get bogged down in semantics. We are all talking about refocussing care around the needs and preferences of people receiving care now or in the future. This means engaging patients, consumers and carers as partners in care - not only at the coal face of care delivery but also in governance to improve the planning, processes and design of care.

There is nothing quite like personal experience of health care or experience of a loved one needing care to really open up your eyes to how care delivery could be improved. In Sydney, Australia where I live we have very good health care on the whole. Recently, my mother broke a bone in her foot after a fall and I spent many hours with her in a hospital emergency department awaiting care. I had two hats on: 'concerned daughter' and 'first-hand witness to patient-focused experience'. The staff worked hard and did their best but at every turn the care delivery system seemed to be designed to thwart the patient. That day I 'walked in my mother's shoes' (actually she leant on me as she hobbled around!). I saw the journey from her perspective. There were so many simple in ways in which that journey could have been better. And I know from the research evidence that this is not just the 'warm and fussy' stuff. This is part of the overall delivery of quality care that contributes to better outcomes for all.

As Jocelyn Cornwell says in her interview, shown here on ISQua Knowledge, it's about all three legs of the stool. You have to have them all to make a quality care experience. So, where to from here? Join us on the cresting wave and be part of the community! I am looking forward to the journey together to making patient-centred care a reality.