How patient feedback makes health care more person-centred

About the author

Michael Greco

Associate Professor Michael Greco is Chief Executive Officer of Patient Opinion Australia, a not-for-profit public online platform that supports health services with an open and transparent dialogue between patients and their providers. See www.patientopinion.org.au or for more information, contact info@patientopinion.org.au

This is a guest blog from Michael Greco, CEO of Patient Opinion

When a patient believes an experience with the health system, good or bad, is worth bringing to the attention of those in charge, nothing is quite as affirming as hearing that the action has prompted a tangible response.

That is a key feature at Patient Opinion, a service that began in Australia five years ago which seeks to ensure that patient feedback drives real improvement. 

At Patient Opinion we have referred hundreds of patient experiences --- complaints and praise --- back to hospitals and health providers.   These individual cases may range from concerns about poor treatment to compliments about attentive care.

Their stories have made a difference.  Hospitals have changed practices (see www.patientopinion.org.au/opinions/62011 and www.patientopinion.org.au/opinions/62034) and promoted a happier workforce (www.patientopinion.org.au/opinions/62594) by passing on what patients say.

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.

This person-centred feedback offers six benefits:

  1. It treats the feedback ‘donor’ not simply as a data source, but as someone who cares about how their feedback is used. That contrasts with an organisation-centric approach that treats 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 encourages 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 enables 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 allows 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 allows 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 encourages 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’.  Below is a table that outlines some of the key differences between a collaborative platform (such as Patient Opinion) and review/rate sites.

 

Review/rate sites

 

Patient Opinion

  • Monologue

 

  • Dialogue
  • Reviews and ratings

 

  • Stories and responses
  • Public role seen as consumers

 

  • Public role seen as change-agents by contributing to what works well and doesn’t

 

  • Focused on informing choice (shopping)
  • Focused on improvement of safety and quality

 

  • Metrics are ‘scores on the doors’
  • Metrics are listening/responding/improving

 

  • Focused on consumers:  typically non-collaborative

 

  • Focused on service providers and consumers – collaborative, working together

 

  • Impact is informing choice
  • Impact is resolving issues, restoring relationships, reducing complaints and wider staff learning

 

  • Informative
  • Transformative

 

  • Collects data
  • Connects people

 

  • Reinforces “us and them”
  • Builds mutual understanding and trust

 

  • Feedback is brief, superficial and rarely actionable
  • Feedback is rich, motivating and full of learning

 

  • No engagement of wider health and care system
  • Can engage all levels of health and care system, including policy, research and education

 

 

 

 

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