How can patient feedback be more person-centred?

We find that hearing the patient voice is central to ensuring better safety and quality across our health services.  Without them our efforts are in vain.  How this voice is heard and translated into action needs reviewing too.  We have to ask the question ‘on whose terms are we engaging with our consumers?’  If we are honest, it is probably on the terms of the health service rather than the consumer. One example of this is the difficulty experienced by health services when comments are posted anonymously by patients or their carers.

Health services often use a variety of patient feedback mechanisms that provide data about patient experience. These include surveys, SMS data, hand-held machines, focus groups, and interviews.  Whilst these mechanisms provide useful data, they may be limited in that they are not independent, nor are they public and transparent, and in many cases not real-time.

We believe that a person-centred feedback system (as opposed to an organisation-centric one) would address the following:

1. It would start from seeing the feedback ‘donor’ not simply as a data source, but as someone who cares about how their feedback is used. It’s important to recognise that an organisation-centric approach is about seeing feedback as data, rather than the feedback being a ‘gift of experience’ donated to us by those who use our services. Such experiences need to be ‘handled with care and appreciation’.
2. It would encourage people to feed back about the issues that matter to them. An organisation-centric approach often wants to know ‘what matters to them’ rather than asking the patient ‘what matters to you’.  An example of this focus is in the family & friends question often used to generate a Net Promoter Score – ‘how likely are you to recommend our service to family and friends’?
3. It would enable people to see whether their feedback has been read, and by whom. This is a key point of difference in most, if not all, patient feedback systems used by our health services. Quite simply, those who provide feedback do not know who is seeing it or how it is being used.
4. It would allow a person giving feedback to communicate with those who are interpreting and acting on it. In this way, patient feedback is everyone’s business not just the managers.  If something has to change, then people need to communicate with those who are making the change.
5. It would allow a person (and indeed everyone else) to see whether their feedback made a difference, and how.  This is the importance of being public and transparent. Nothing is done ‘behind closed doors’. At the end of the day, it is the people’s health services as it is their taxes that fund the health system.
6. It would encourage everyone who can learn from and act on feedback to participate openly. Such learning can be internal (across all staff) and external (between health services). Even in a competitive environment, health services can demonstrate how they listen and respond to negative stories.

At Patient Opinion this is the kind of feedback platform we’re creating, and we’ve come a long way (though there is further to go). We think that by working in this way, we can support new kinds of collaborative relationships between those who need care, and those who provide it. 

We think a modern feedback system should be about more than collecting data.  It should be about empowering people (patients, carers and staff) to work together for better health and care.  

By contrast, systems which simply ask you to "recommend", or to "rate and review", cast citizens in the role of consumers, not change agents.  As change agents we begin to see those who use our health services as a valued asset in supporting safety and quality, and teaching our staff what it feels like to be in ‘the shoes of the patient’. 

The key differences between a collaborative platform (such as Patient Opinion) and review/rate sites are as follows.

TripAdvisor-type sites tend to have the following characteristics:

• Monologue
• Reviews and ratings
• Public role seen as consumers
• Focused on informing choice (shopping)
• Metrics are ‘scores on the doors’
• Focused on consumers:  typically non-collaborative
• Impact is informing choice
• Informative
• Collects data
• Reinforces “us and them”
• Feedback is brief, superficial and rarely actionable
• No engagement of wider health and care system

Patient Opinion's characteristics are:

• Dialogue
• Stories and responses
• Public role seen as change-agents by contributing to what works well and doesn’t
• Focused on improvement of safety and quality
• Metrics are listening/responding/improving
• Focused on service providers and consumers – collaborative, working together
• Impact is resolving issues, restoring relationships, reducing complaints and wider staff learning
• Transformative
• Connects people
• Builds mutual understanding and trust
• Feedback is rich, motivating and full of learning
• Can engage all levels of health and care system, including policy, research and education