One way of addressing this problem in business is by holding focus groups and customer panels. I recall suggesting to one large organisation in which I was involved that we should have customer panels. The chief executive said it was a good idea and put customer panels in place, but the panels reported to a management consultant who produced more paperwork. It was very useful work, which produced good information, but it did not have anything like the impact of what I call "listening from the top". I refer here to finding some way in which the people at the top, in this case running a hospital, found a way to be closer to their customers or patients. One way to do that is to ensure that those who run the businesses or hospitals find time to be available on the floor. One way we do it in business is to have the manager's office on the floor so that he is available, contactable and approachable by the customers as well as everyone else.