Author Profile Picture

Lilith Arevshatian

Kingston Business School


Read more about Lilith Arevshatian

NHS Customer Service – forget about process, it’s about emotional engagement


There’s so much rich insight coming out of the academic sector that HR professionals need to know. At Academics’ Corner we feature the best HR researchers that tell you what they’ve found and what you need to do differently on the back of the research. Get connected to the academic sector through Academics’ Corner and make sure you never miss another piece of key research again. If you’re an academic with a relevant story, please get in touch on

In a quest to modernise the National Health Service (NHS), the Department of Health put forward customer service functions similar to those provided by the private sector.

A prominent example of this is the introduction of the Patient Advice and Liaison Service (PALS) across healthcare organisations as a front line function to resolve patient concerns before they escalate into complaints. While the aim is positive, research shows that in the context of healthcare, customer service workers can experience conflict between the call centre’s mass production ethos (which favours speed and quantity) and the caring premise inherent in providing healthcare (based on nurturing and emotion work).

Companies must acknowledge and appreciate the significant emotional involvement that customer service workers have with the public. 

So how can managers and HR professionals support this special type of customer service worker?

Research conducted by Lilith Arevshatian and Rachel Lewis highlights the following issues:

  • Healthcare customer service workers are not ‘just’ customer service workers. Their job involves significant emotion work and the sorts of issues they deal with range from suicide threats to grief counselling. For example, one PALS worker explains that, “this isn’t just about process, this about actually engaging with people face to face. Talking to them, talking about their worries, their concerns, and things like that”.
  • The term ‘customer service’ is misleading. While customer service workers in other industries can easily resolve issues by replacing faulty goods or offering refunds, customer service workers in healthcare deal with ill patients and their loved ones. This is not like contacting a mobile phone retailer’s call centre and complaining about loss of coverage. A PALS employee stresses that, “the ‘customers’ that we have are not the general customers that they wanna put under the same umbrella”.
  • Relatedly, it is not surprising that PALS workers are dissatisfied with their job titles, which erroneously only allude to the processes involved, and ignore the significant emotional component of their role. Job titles include ‘telephone advice worker’ or ‘customer service manager’. Understandably, a PALS worker shares, “I just don’t feel that they [managers] really get the level of involvement we have with patients. What it means, what it takes out of you”.

As a result of working in a misunderstood and misidentified role, PALS workers experience significant distress. Research by the above authors shows that PALS workers experience worse wellbeing than customer service workers in other sectors.

Organisations should conduct a thorough job analysis and re-consider the job design of customer service workers

In fact, their reported level of wellbeing is more comparable to the wellbeing of social workers. Compared to the UK general working population, PALS workers experience pretty high job demands and have a conflicting role in the organisation. It is therefore not surprising that one PALS employee describes her job as being, “the NHS outside toilet”.

Based on these findings, we recommend that organisations:

  • Acknowledge and appreciate the significant emotional involvement that customer service workers have with the public. Organisations should provide their teams with opportunities to de-brief, particularly after challenging contact (e.g., suicide threats, death threats), and consider clinical supervision (much like psychologists and social workers get). Mentoring programmes are also highly advisable for complaints services (e.g., ombudsmen).
  • Reconceptualise the role of customer service and re-examine which organisational department or function it should sit in. If it resides within administrative functions, we recommend transitioning the service into a more appropriate department (e.g., safeguarding, patient experience).
  • Reconsider the job titles allocated to their customer service workers. Currently, job titles, such as ‘telephone advice worker’, do not appropriately identify this employee group. New job titles should imply the significance of the role.
  • Finally, we urge organisations to conduct a thorough job analysis and re-consider the job design of customer service workers, particularly those who might work in a ‘caring’ environment (e.g., 999 operators, local government ombudsmen etc.). Stress management measures and appropriate reward and recognition practices must be implemented to support and enrich these extremely valuable groups of workers.
Author Profile Picture
Lilith Arevshatian


Read more from Lilith Arevshatian