There is a growing body of evidence that patients’ experiences with healthcare are a reliable measure of its quality.1 A systematic review showed clear evidence of the association between patient experience, clinical safety and effectiveness, and health outcomes.2 When seeking out ways to better the patient experience, direct feedback is vital in this process.
Every healthcare organisation collects patient feedback in one way or another however the challenge them is their ability to gather patient feedback that is meaningful and useful in driving quality improvements. Feedback needs to be collected in a timely manner, with staff and the community being part of the feedback process.
This all makes good sense, but at times it’s difficult to simply stop to reflect. With an understanding around the need to collect patient feedback, is there a full understanding around the purpose of collecting patient feedback?
It’s clear from the above that if we can improve patient experience then this will have an impact on safety, quality and health outcomes. Hence, in this way, gathering patient feedback is for the purpose of performance measurement. We collect data from patients to measure this performance, usually as a metric such as a Net Promoter Score (NPS).
… the experience of complaints handling can be a difficult and time-consuming exercise.
Another purpose of gathering patient feedback is to resolve complaints. Patients are invited to share their concerns through a complaints system, where the organisation aims to resolve issues as quickly as possible. It’s hoped that this process results in learnings to drive improvements throughout the organisation. In saying this however it’s generally considered, from the patient and organisation’s perspectives, that the experience of complaints handling can be a difficult and time-consuming exercise. Further to frustrations, when continuously focusing on negative experiences, a complaints-culture can develop, which unfortunately does not transform into an improvement culture.
And yet there is another purpose of feedback that takes a more citizen-centric approach, and where public online feedback can play a key role in its success. Both performance measurement and complaints handling tend to be a ‘one-way’ process – organisations collect data from patients, but patients receive little in return, and in many cases, are unsure what impact their feedback has had on the organisation. If feedback systems were able to shift to become more citizen-centric, they would enable the consumer to see who was reading their feedback, how it was responded to, and whether it made a difference.
Whilst many health organisations have feedback mechanisms in place (e.g. surveys, focus groups, Patient Reported Experience/Outcome Measures PREMs/PROMs), it seems that their processes are more about collecting data, for the purpose of measurement and hopefully improvement, rather than bringing together the consumer and provider in a conversation that builds trust for both the individual patient and the wider community. This former approach is important; however, having the ability to better engage and connect sees feedback as more of a ‘two-way’ process (a dialogue) rather than a ‘one-way’ process of collecting data. Such an approach moves the feedback process from being just a ‘transaction’ to more of an ‘interaction’ where the connection is more relational than just data collection.
With the advent of social media, health services are now under greater public scrutiny…
When considering the way feedback is collected within healthcare services, majority of feedback mechanisms tend to be ‘in-house’ rather than more public or transparent, which provides an opportunity for everyone to learn from the feedback (providers, various stakeholders and the wider community). This again links us back to our question: what is the purpose of patient feedback?
With the advent of social media, health services are now under greater public scrutiny than in the past. Social media is having an impact on the ways that citizens are engaging with each other and with public services. This is outside anyone’s control and obviously bigger than health policy. Recognising this significant role that the online space plays in day-to-day life, engagement tools need to evolve to match the way in which citizens prefer to connect.
This is part of what Care Opinion Australia offers. It’s about preparing organisations to be future-ready, rather than simply continuing to use twentieth century systems. No matter how perfectly these systems seem to suit the current needs of health organisations, it’s inevitable that they will soon be outdated and unable to fulfil all operational or consumer needs.
Care Opinion, now in several countries, is about a new way of consumer feedback that is more than data collection. Its purpose is to provide a platform of CONNECTION, where the storyteller can engage with the service in a safe, public, transparent, and meaningful way. As a result, the process of feedback and engagement is more citizen-centric in that the consumer receives something from the ‘gift of their story’ (e.g. they can see who is reading their feedback, how it is being responded to, and whether it makes a difference).
When the health service truly engages with their patients in a non-adversarial environment, patients have tangible evidence that they are being listened to. A public online form of engagement can be a scary prospect for health services but pales in comparison to the angst a vulnerable patient might feel when addressing issues on a personal level with them.
… when patient engagement is a positive learning experience…
To make this work, Australia will require champions that have as their motto ‘your story helps us do our job better’. Care Opinion moves beyond a tick-box approach to gathering information about patient experience yet complements these feedback systems that are currently in place It moves beyond suggestion boxes or ratings, or even complaints. It encompasses more than this because health service staff are able to engage more promptly and directly, more so than with their ‘in-house’ mechanisms. Although managers are responsible for gathering patient feedback to meet national requirements, performance metrics and complaints, what grabs the attention of staff is when patient engagement is a positive learning experience for them. This is more about patients becoming ‘energy-sources’ and not just ‘data-sources’ to give greater purpose to the collection of patient feedback.
Care Opinion Australia is a not-for-profit organisation that exists to help the health and social care system become more responsive to the consumer voice by providing a platform to enable open and transparent dialogue between patients and health service providers. Through the Care Opinion website, the public can publish their experiences of local health services. These services are email-alerted to the story and are able to reply online in near real-time. The website allows health service staff to interact easily and safely with patients and consumers to help improve care.
Contact Michael: firstname.lastname@example.org
About the author
Associate Professor Michael Greco is a founding director and Chief Executive of Care Opinion Australia (formerly Patient Opinion), a not-for-profit charitable organisation. He is also Executive Director for CFEP Surveys which provides survey tools for organisational and clinician professional development. He has been a board member for a number of not-for-profit organisations including CheckUP Australia, and currently he sits on the Board of Health Leaders Australia. Michael holds a PhD in medical education and a Bachelor of Theology. He holds a professorial post at the School of Medicine, Griffith University (Qld), and is an honorary senior research fellow at the School of Medicine, University of Exeter (UK).
1 Matthew P. Manary MSE, Boulding W et al. The patient experience and health outcomes. N Engl J Med 2013; 368:201-203. Available at: nejm.org/doi/full/10.1056/NEJMp1211775.
2 Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 2013; 3:e001570;doi:10.1136. Available at: bmjopen.bmj.com/content/3/1/e001570