The confusing world of NHS patient feedback
Over the last ten years or so there has been a huge rise in ways in which members of the public can give feedback about their experience of health and care services. This information is one of the ways in which service providers such as hospital trusts, as well as commissioners of these services can get an insight into the quality of services and what needs to improve.
These days there are a range of channels through which people can leave feedback about their experience. These have a variety of purposes:
- Complimenting or complaining about a particular service or experience that will help a service improve.
- Giving a rating that helps other potential service users to decide whether or not to use a particular service
- Creating a dialogue between a ‘customer’ and a provider which might help resolve a problem and build a relationship
- Giving commissioners an insight into how a service is performing through looking at public feedback in the round and comparing this against others.
I think there are 3 main ways in which the opinions and views of people are captured. Some of these rely on the public taking the first step and others reach out to the public.
- Provider organisations all have some way to capture comments and complaints from individuals. These are are specific to the organisation and rely on individual members of the public finding their way to them – they include in house complaints, Friends and Family, PALS services etc.
- Another channel that relies on the public finding their way to them are specialist or stand alone feedback organisations or services such as Patient Opinion, Healthwatch Rate and Review and NHS Choices – these rely on their own publicity or commissioners/providers promoting them.
- Then there are National and Local Surveys that pro-actively reach out to the public and try capture a representative sample of peoples experiences of particular services. These may be useful at a national level but their sample sizes are often quite small at a provider level.
Of course it is not quite as neat and tidy as this – for example Friends and Family is provided at an organisation or service level but there is an expectation that providers will pro-actively encourage people to use it.
Different approaches different insights
The situation is further complicated because these mechanisms vary:
Most are service specific – they focus on peoples view of for example a particular GP or a certain ward.
The one that is probably most sophisticated and different is Patient Opinion which starts in a different place – it asks people to tell the story of their issue and from this constructs and connects with various services who may be able to respond.
Patient Opinion is interesting because it tries to respond to the whole person rather than just treating someone as though they are the sum of their condition. I think this is particularly important given that local health systems are increasingly trying to develop more integrated and personalised services.
The situation is further complicated by how well signposted feedback services are. Here are examples with web links from three NHS Trusts.
This is one click from the main page of the website by clicking on the tab that says ‘your feedback’ one gets access to a range of internal feedback mechanisms.
This is also one click from the main page but a bit harder to find – its on a tab saying ‘Contact Us’ and the feedback form comes after some more administrative information.
Here the link to feedback is shouting out on the main page – although a bit confusing there are then links to internal complaints, comments and advice on how to get in touch with advocacy services.
None of the above organisations appeared to promote independent channels such as Patient Opinion or Healthwatch Rate and Review.
I think that there is inconsistency with regard to how feedback mechanisms are used across the health system. With different channels of varying utility and a wide variation in terms of how they are promoted. For example the government suggests a variety of ways in which Friends and Family information can be collected:
- There are few constraints on the technology used to collect the data, and a number of different methods would be suitable, for example:
- On-line rating: patients are given information including a web link which they can use to log on, enter a reference number and provide their feedback
- SMS/Text message: patients are given the question at the point of discharge, and are able to text their response (providing an opportunity to send follow-up questions to responders)
- Smart phone apps: patients are given details of the app, including a unique reference number, at the point of discharge
- ‘Voting booth’ kiosks or hand held devices: positioned in the location from which the patient is discharged, with ‘voting’ controlled to allow each patient to only vote once
- Telephone survey – patient is given a freephone number and a unique respondent ID to respond within 48 hours
- Postcard solutions: patients are given a postcard at discharge with an option to complete and return on site or to complete at home and post back.
This variation and the range of different feedback channels makes it harder for the public to decide which one to use and more difficult for providers and commissioners to assess the overall picture of public opinion about services.
Its interesting that Healthwatch England have now entered this area with ‘Rate and Review’. While the logic of this is clear – it brings a systematic way for them and CQC to keep in touch with public concerns it also raises more fundamental questions – in particular how they get the balance between being the provider of a feedback channel at the same time as being responsible for stress testing whether or not a system offers adequate and consistent opportunities for feedback.
I do think that there needs to be some thoughtful work done to consider what good might look like and the respective merits of different feedback systems to ensure that we don’t just gather feedback on individual experience but capture this in a way that helps us to develop more integrated local systems.
What do you think?