Operating on the customer’s heart

How does it feel to be the customer when your heart is being operated on? Hugh Burkitt describes his recent encounter with the business end of healthcare

It is a cliché in marketing that we must put the customer at the heart of the business, but I recently found that my heart was at the centre of someone else’s business. I needed an operation to repair a leaking aortic heart valve. Two organisations have helped put me back at my desk – the NHS and Aviva Healthcare – and I am profoundly grateful to them both.

The customer need

It all began back in May, when I decided after several weeks of coughing that I should get along to my doctor for a check-up. The cardiologist was brisk to the point of being brusque. He had no ‘bedside manner’ but he was logical, clear and direct. Having identified the problem he recommended I go and see a surgeon. I asked: ‘What will happen if I don’t have an operation?’ ‘Your heart will fail,’ he said.

Finding the right service

So I went to see his recommended surgeon and fortunately immediately liked him. He described the problem and his proposed solution with great clarity. The aorta needed to be brought back into shape and this should cure the leak in my valve, but if it didn’t he could put in an artificial one. I needed to have the operation done ‘in the next four weeks’. The risk of an ‘event’ rose exponentially with the extent of the dilation of the aorta and mine was already at a dangerous level. Oh, and the mortality rate for the operation was ‘less than 4%’. The mortality rate was mentioned on at least two other occasions before the operation and it weighed heavily on my mind.

Is 4% low or not? Well if you say to yourself there are 50 people on this rush-hour bus, and two of us are going to die before the final stop, then it starts to seem quite high.

The stricken faces of one’s nearest and dearest also tell you a lot. We all need a heart that works and it has been possible only in my lifetime to operate on it. Messing with the heart sounds alarming, though more than 300,000 people in the UK have now had heart surgery, and the outcome for most people is excellent. But going into the operation, while outwardly calm, I was frankly scared.

Would Aviva pay for it?

During this period there had been a series of telephone conversations with Aviva Healthcare, which had established that my policy did cover this operation and that my preferred surgeon was acceptable – but his recommended hospital – The Harley Street Clinic – was not covered. Aviva would pay the average cost of five NHS trust hospitals for this operation – which was a cool £22,500 – but they warned me that The Harley Street Clinic could cost twice this amount and I’d be on my own for the extra money.

Each call to Aviva was dealt with efficiently, but every single call was with a different person, and it was quite clear that they were in much more of a panic about what my policy covered than the fact that I had a serious health problem.

I never established any one person at Aviva who recognised me, and I never had a written communication from Aviva to me that addressed me by name. The only paperwork I received came from a computer in the accounts department – not from anyone interested in health care.

So I decided to settle for my preferred surgeon operating at his NHS base in two weeks’ time, which was a specialist unit run by UCLH called The Heart Hospital. As one visitor later said: ‘The name is reassuring. It sounds as though they know what they are doing.’

Delivering the service

The surgeon was no doubt happy to have me as a private client, and the fact that I was private may have helped move me up the queue, but on the planned day of admission I still had to call at 11.30am to check that there was a bed available, and when I did I was told that I would have to wait until 1pm to hear for sure – ‘after the doctors have done their rounds’. As I got a call back my pulse rate leaped – something it was to do a lot of in the next few days – but I was in.

The first three of my six nights in hospital were all grim. I shared a room on the night before my operation with a charming man, but his appalling cough kept both of us awake. At 1am, I considered discharging myself and coming back again in the morning. The next day, as the hour of my operation approached, my rising tension caused my backache (a relic of sporting activity earlier in the summer) to grow worse and worse. When the anaesthetist came round he offered me painkillers and a sedative. ‘I’ll take anything you’ve got,’ I said and as soon as I took them I passed out and didn’t wake up again till I was in the intensive therapy unit after the operation.

Here they were talking to me to wake me up and taking a breathing tube out of my mouth. I stared at the neon lighting and felt cheered that I was not in the next world after all. My partner, Antonia, and I had attended a pre-operation orientation day two days earlier which had wisely included a trip to the intensive therapy unit. There we saw what people looked like when they came straight out of the operating theatre. In a word, ghastly. They looked a terrible colour with tubes everywhere.

Once I was conscious I became acutely aware of the state of my neighbours in the beds on either side of me. On my left was a Polish granny who was said to speak not a word of English, and on my right was a Mr Ahmed who was said to speak only Urdu. The blue curtain blocked out vision, but every sound from the beds next to me was audible, and I found myself being drawn into each patient’s personal drama.

I settled uneasily down for my third night in hospital which I can confidently say was the worst night of my life. Mr Ahmed’s alarm kept going beep beep and every time it did my pulse rate leapt and my alarm beeped once in response. After some hours of not sleeping I heard a highly cultivated English voice from Mr Ahmed’s bed repeating over and over again: ‘Hello I’m Barney Ward.’ Who was this? Clearly a posh new patient had arrived straight from the operating theatre. What had happened to Mr Ahmed? Had he become one of the lost 4%?

But when light finally dawned, Mr Ahmed had reappeared, and Barney Ward was nowhere to be seen. Mr Ahmed did speak English, and now he was protesting that he didn’t want to sit up, as two wonderful male nurses – Matthew and Alfredo – set about waking up the entire ward and throwing off our post-operative stupor.

Even now, months later, I feel quite emotional when I think of the wonderful care I received in that ward from so many different staff, who were all working over the weekend. Matthew and Alfredo stick in my mind because they had such a wonderful effect on the whole ward on a sunny Sunday morning after a very dark Saturday night. After what had seemed like a very long period in captivity – in fact only three nights – I could look out through an attic window at the peaceful roofs of Marylebone and look forward to the rest of my life.

Reflecting on my treat ment

My message to readers is this: do get your health checked regularly. My condition might have been fatal if I had left it too much longer.

My message to Aviva (as to all healthcare providers) is simple: as with all good communication you need to put yourself in the place of the recipient. People facing a heart operation don’t feel great about it, and would like to be treated sympathetically as individuals. It must be possible to be clear and businesslike about the money involved, while at the same time appearing to be interested in the patient’s health.

My message to the NHS is more complex: well done on listening to a lot of feedback and introducing such customer-friendly measures such as an individual patient manager – in my case it was a nice lady whom you felt might otherwise have been running a National Trust Teashop – who popped in each day to listen to any concerns over my stay in hospital. She had no medical role and didn’t have the power to change anything, but she was there to listen and pass messages on.

So she couldn’t do anything about the truly disgusting food. Even the tea tasted terrible. I think that if a tea manufacturer could be persuaded to sponsor the tea bags in a major London hospital for a trial period of a year they would be able to demonstrate a speedier recovery rate among patients. And surely the alarms in intensive care could be visual rather than aural, in a way that would alarm the staff but not the patients.

Finally, I do wonder why we don’t all come out of an NHS hospital knowing what our treatment cost. On my last day I encountered another patient leaving who was complaining to anyone who would listen about the poor treatment he had received. This included an emergency ambulance into hospital, a new heart valve, a triple bypass and a pacemaker. He was, he told me, aged seventy, overweight, a lifelong smoker and had diabetes. His ‘free’ treatment must have cost the NHS at least £50,000. He may not have valued the professional expertise he had received but surely he would have been quite impressed by its cost.

Hugh Burkitt is chief executive of The Marketing Society

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Featured Image: People facing an operation don’t feel great about it, and would like to be treated sympathetically as individuals