As I mentioned last time, I’ve only once found an impromptu use for my understanding of consumer behaviour and consumer psychology, and I certainly never anticipated that a situation might arise where market research might make a difference between life and death.

But that just shows how little I know.

Recently, the UK government has announced that 10% of hospital (NHS Trust) funding will be dependent on patient satisfaction levels.  To put that in financial terms, that could mean around £10billion of expenditure will be dependent on patient satisfaction.

And here’s the thing.  This is, in my opinion, the most profoundly stupid example of using market research that I have ever encountered: it’s going to result in lives being lost.

Let’s go back a few years, before any of us had heard of MRSA or any of the other so-called super-bugs that are resistant to antibiotics and kill people.

How many patients would have walked out of a hospital thinking, “There was a risk of me contracting a life-threatening bacterial infection in that hospital, I’d better market them down to a 5 out of 10.”

Ah, you may say, but people might have said the hospital wasn’t very clean.

That’s true.  But against what standard of cleanliness are patients judging the hospital?  Most of us are fortunate enough not to visit hospitals too often, so can we really judge what properly, hygienically clean looks like?

Of course, now that we’ve been primed to think about something as important as super-bugs we’re very sensitive to how clean a hospital looks.  But we don’t know how effectively they are controlling this type of infection from what we see; that requires expert testing.

It might be useful to know what people are actually doing in the hospital.  Are they reporting toilets that they find are dirty?  Are they cleaning up after themselves effectively where they can?  Are they washing their hands properly?  Are they using the special sanitising products provided?  Are they only coming to the hospital as visitors when they know they aren’t carrying a cold or stomach bug?

There is no shortage of evidence to show that people are hopelessly poor at reporting this sort of information accurately – not that, as far as I know, anyone is proposing to ask them what they are doing.  It’s all about what  they think.

I don’t think the NHS is perfect – far from it.  But I don’t think that I know how to judge how it’s performing in totality.

If someone happens to go for an out-patient appointment and is kept waiting for two hours they would feel bad.  In completing a survey they would probably exhibit be a ‘halo effect’ whereby they misattribute that bad feeling to many aspects of their experience.  Now if the delay was caused because the doctor in question was saving a life elsewhere would the patient realise?

Individual patients don’t have the perspective or the expertise to judge how well a hospital is performing.  But these inexpert, myopic opinions, when collected in their thousands and pressed together in a report, take on a gravity that is totally out of proportion to the base data.

And people will almost certainly die as a result.

Money will be wasted.  It will be wasted on the survey process itself.  It will be wasted on implementing the wrong solutions.  It will be wasted because the hospitals will invest in playing the game – anticipating what they think patients will want to see and hear to give them good scores.

All of these will drive money away from the expert evaluation of hospital effectiveness, drug funding and objective decision-making that should be taking place on the basis of managers doing the best job they can, as experts in the hospitals they are tasked to run.

You may never hear someone say, “Market research saved my life”, but if you’re unfortunate enough to need the UK’s National Health Service and not get the care you need, market research might just be responsible for you not living.

Philip Graves


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