Patient choice means NHS organisations must act more like businesses to win customers. The best will look to companies like Apple, which build their services from the 'outside in'

The NHS is in the midst of a choice revolution. The goal of free choice of hospital care has been reached, several years after the journey to liberalise access to hospital began. Health minister Lord Darzi has made it clear that patient choice is a fundamental right of all patients and now has GP and community health services in his sights.

But the revolution is incomplete. The NHS has mostly grafted on the mechanisms of choice without changing its fundamental belief system. It has not put patients at the centre of its thinking. Customer focus may be the new mantra of forward thinking managers and clinicians, but often this is skin deep.

This diagnosis is not intended to knock the NHS or portray it as the dull-witted cousin of the dynamic private sector. Many private sector companies fall into the same trap. Many will fail as the credit crunch exposes management weakness.

These sorts of companies think first about their shareholders and how they can meet their needs. We call this thinking from the inside out. Shareholders' not customers' needs determine how the company operates and its priorities. These organisations are not averse to change - they often invest in big reconfigurations to meet shareholders' performance targets. But nor do they have staying power.

Successful private sector companies, in contrast, think from the "outside in". That means they start with a clear understanding of what their customers want and only then do they design their operating model to deliver this. Think Apple, Virgin or First Direct and you begin to get the idea. These companies research the unique needs of their current and potential customers and design products precisely to meet those needs. Their structure follows from, rather than leads, this process and continuously adapts in response. These companies are usually the winners in the battle for market share. As the recession starts to bite, customer centricity will increasingly determine who survives when the going gets tough.

Of course, competition in the NHS has historically been limited. The bargaining power of suppliers is generally strong, the threat of new entrants is low and there is little real product substitution. But this is changing.

The operating framework's principles and rules of co-operation and competition are creating a transparent and level playing field on which providers will compete. Some of the old behaviours (and cartels) will be outlawed. The new national co-operation and competition panel, chaired by Lord Carter, will begin to police implementation of the "rules". For some there will be no hiding place.

The customer is always right

If suppliers of services must invest more to understand what their customers want, then patients must act more like customers. Even using this sort of terminology feels uncomfortable for some. But if you substitute "customer" with "empowered patient" this vision does not feel as alien.

Empowered patients are those who exercise control over their care and have the information to compare different offerings and make informed choices. This is as much about choosing how and what care should be delivered as it is about switching between providers. But patients can and should be supported to overcome this. Care co-ordinators or case managers for people with long term conditions and better information about care and outcomes are all solutions to the problem of empowerment.

Choice is not the only mechanism by which the customer's voice can be heard. Customers can exert pressure on providers, for example through active membership of foundation trusts. For their part, foundation trusts should cherish the involvement of their members and not see them as an irritant. Imagine the welcome Tesco would give customers willing to give up their free time to instruct management on how better to meet their needs.

In the new market, successful providers and commissioners will be those who listen and respond to patient needs. In any given market they will segment their customers into different profiles for whom they will offer personalised services. This sort of intelligence is not cheap, but it is essential. Consider polyclinics in this context - what an amazing opportunity for providers to understand and deliver what customers want.

The rewards are significant. We will have a health service that expands its view of quality, building on clinical quality to encompass patient experience, is inspired by good ideas from above but implements them by thinking from the outside in, co-creating with customers. We will have a health service that carries a brand that goes beyond clinical outcomes to satisfied customers.