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BMJ Journal: Public web ratings identify great care

December 2, 2012

Ratings from patients on independent, commercial websites are highly significantly correlated with the quality of the hospital (p < 0.001), if you consider mortality and readmission rates to be important markers of quality (I do). This work was carried out in a department of paediatrics and published in a quality BMJ journal – this is not some small study.

What might this mean?

1. It is yet more, peer-reviewed evidence that ratings given by patients are accurate predictors of quality of care – the wisdom of the patient.

2. The title of this paper is important “commercial, website ratings”. This is not hospitals doing surveys, it is not the traditional approaches of market-research, it is not central, bureaucratic data collection. It is patients and their relatives deciding to go online and use an open, public website to give a rating and a review (note, there is no need to “authenticate” the patient, or otherwise check that they really are a patient. Hint to the flat-earthers: people by and large do not pretend to be patients and give false reviews. When they do they are normally doctors trying to make themselves look good, and the technology detects these charlatans.)

3. This research is not about the net promoter score (an internal, management tool designed to inform organisations). Whilst that has its place, it has NEVER been proven to relate or correlate to healthcare quality.

4. We can probably save a load of money, on the outmoded approaches that do not work, and which do not prevent instances of awful care. The NHS (and all healthcare systems) spends a fortune on collecting data, measuring process and monitoring mortality rates. As it becomes clear that essentially some free websites can give insight and data that is predictive and sensitive about quality of our NHS, we can stop wasting money on approaches that rarely if ever predict problems – but which merely report the next shocking (yet, unsurprising) “appalling lapses of care”.

5. We need to do more work on this. These are early days, but more and more of the evidence points to the same thing: independent, websites can be useful in helping identify the quality of care. As more research is done on this we will find out exactly why these seem to be so useful, and how hospitals (and patients) can best use this information. The hospitals who are the early adopters in this (and their patients) will be the winners.

6. As sure as bacteria spreading across a petri dish, we will find that these same benefits can be harnessed for other areas of care – especially primary care, community services and mental health. (Indeed, iWantGreatCare has increasing evidence for exactly this – including at the level of the individual clinician.)

7. The Friends and Family Test is highly likely to deliver these same benefits to the NHS if it embraces the same principles and methodology: openness, transparency and using approaches that the public expects and which are used across the rest of society: online web-ratings on an independent site. Note, this study does not use some intricately worded question, does not invent some new five and a half point scale – it is simply the now “web classic”, rate out of five. There is no evidence to suggest you will see such important correlations when asking patients to SMS their score, or use bedside kiosks or internal tablets. (clue: it’s the web). A simple, standard methodology.

8. The internet changes everything (okay, so I know that’s obvious, but I just wanted to type it). I was speaking at the Kings Fund this week and heard a lot of people agree with Angela Coulter when she said that doing yet more patient surveys would not make things better. She is so right. The work she and others have done is absolutely fantastic and all of us in this area owe a huge debt of gratitude for raising the profile and importance of patient experience. But as she says (and I think Einstein would agree with her), doing more of the same will get the same results. That is why this study and the work already being done by doctors and hospitals across the UK to ask their patients to use open, independent, commercial (e.g. as commercial as those doctors who contract their services to the NHS) websites to provide feedback is so important. It is not more of the same, it is completely different.

9. No doubt we are about to hear the next case of “shocking mortality statistics” in the NHS. But of course, that is shutting the stable door after the horse has not so much bolted, as died. Harnessing patient experience through public sites that allow ratings and reviews may well have the ability to predict and thereby prevent such tragedies. As I’ve said before, I believe that patient experience (done properly) is the smoke-detector of patient safety and care quality. This paper just adds more evidence to support this view and should give huge confidence to those who were concerned that such an open, unregulated approach could not work.

10. Prediction: real-time, open, transparent patient ratings and reviews on independent websites will soon play a major role in monitoring and measuring quality (CQC using a TripAdvisor of the NHS – inevitable), and will be used to adjust and assess risks of litigation across the NHS.

11. So I’ve written this post for doctors, managers and politicians who still fail to see the huge power of such an approach. But on one level that doesn’t matter because the most important people already know all this – guess who?

Patients and the public are way ahead. That’s why the reviews are there, that’s why Yelp, iWantGreatCare and others do this – because we know there is massive demand, and the only reason there is demand is because the wisdom of the crowd knows this is one of the best ways to get truly great care. When people search on the web for health information today, they are more likely to be looking for the ratings and reviews from their peers, as for information from the CMO, local hospital CEO or Royal College.

And no, this isn’t all about “choice” (but it will increasingly be so) – it is often just to be sure that the person they are going to see is thought of highly by other patients like them, or to see that their peers are holding their local hospital to account.

12. Finally (and please can the few doctors who still state this as a “fact” now start to base their comments on the evidence – i.e. stop propagating a fear-based rumour), most reviews are not negative. In fact, the exact opposite is true – whether on Yelp or on iWantGreatCare, the majority of reviews are highly positive: incredibly grateful patients and their relatives saying thank you to those who do so much to help them with professional skill, empathy and ensuring the utmost dignity. The reviews are added to say a very public thank you, but in so doing are creating a resource that will become one of the most valuable in healthcare – a quick, cheap, simple and robust way to identify and predict healthcare quality. Sounds like a magic bullet…

…measuring and monitoring patient feedback is worthwhile. It works.

Dr Mark Newbold, CEO Heart of England NHS Trust








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