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Do patients actually want to give feedback on care?

July 4, 2012

This was the question posed to me at a recent conference at which I was presenting. It was asked by a senior doctor. I wanted to share the answer I gave so as to get thoughts and comments from others.

I’m not sure – with all respect to the person who asked – that this is the right question to ask.

There is a considerable evidence that patients (and their families) want to:
1. say thank you for the care they receive if it is good
2. highlight excellence, especially of staff who “go the extra mile”
3. point out problems and errors to protect next patient and prevent repetition of failings (still the main reason for litigation – which could be considered as “feedback” that patients fall-back on if we don’t provide alternative routes for feedback that they trust and which are transparent.)
4. help ease journey/anxiety of next patient/peer going through the care journey they have just experienced.
If we accept these points then issue is how we do it and meet those needs of patients and service users.
  • Do they want to fill in ridiculous long paper surveys that ask 40 questions to which they never see the answers, and they cannot see how it helps the next patient? Of course not.
  • Do they want to fill in feedback on a grubby looking trackpad when an inpatient and struggling with illness, pain, worry, treatment side-effects? Would you?
  • Do many people have the time to sit down and write a letter to CEO saying thank you, or negotiate the tortuous DH/Choices website? A tiny minority of all those who get care.
I’d suggest question is not “do they want to provide feedback?”, but rather how can we best help meet their needs (and increasing expectations) to engage in a transparent, open, modern dialogue that meets points 1 to 4 above.
Too many attempts at – and current solutions for – harnessing the huge power of patient experience feedback have been thought about from position/view of the organisation, or even worse clunky attempts to bring “net promoter scores” or other management structures from non-medical sectors. These don’t work, end us as tick-box exercises and do not engage patients or staff.
As one CEO said to me recently, “the net promoter thing we just do for the SHA, it does not improve anything and does not give me the insight I need to run my organisation”. How many Mums would choose a GP to care for their child based on a net-promoter score (even if they knew what one was!)? Would you select the surgeon to operate on your brain based on the hospital’s overall score? And is there a single doctor or nurse in the UK who has changed her behaviour and attitude based on the results of the national patient survey?
Real-time, open, transparent systems that allow patients to share their thoughts and experience of care with their doctors, hospitals, friends and the public are very different to the majority of “feedback” collected in healthcare today. But not so different to how nearly every other service industry operates.
Done properly (i.e. more than collecting a few stories) such systems also collect the hard metrics needed to assess and improve quality. Modern systems to harness patient experience meet all the needs of the patients and the public as outlined, but also provide the clinicians and provider organisations with robust, comparative metrics that can be used to improve an organisation, to drive quality improvement and to demonstrate to commissioners and purchasers the quality of the services delivered.
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