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How can feedback from patients improve care?

Bev Fitzsimons 05 May 2016

Bev Fitzsimons explores why the NHS is struggling to improve patient experience despite collecting vast quantities of data, suggesting that harnessing the unique insights of patients would be more effective.


At first sight this seems a simple question, and one that has been cracked by myriad businesses already. How many times this week have you been asked to “rate your experience” of something, or even “leave packaging feedback” for something? How many times have you deleted the said emails, without even opening them? And why is that?

I began to think about these questions recently when I attended the King’s Fund’s conference “How to use patient feedback more effectively to improve services”. This event looked at the information currently collected from patients, and what can be done with it to improve patients’ and service users’ experiences.

Volume of patient feedback in the NHS

It is undoubtedly true that the NHS leads the field in collecting feedback from patients via surveys, the friends and family test, Patient Recorded Outcome Measures, among others, and has done so over a long period of time. However, the question remains what has been achieved with the considerable resources, time and effort from patients, NHS staff, and others in undertaking this activity?

Different sorts of data are useful for different purposes, with surveys having an important place in tracking changes over time and for making comparisons between organisations. But as a system, we haven’t made great use of this data to really look at trends over time – it does beg the question whether surveys really are used to drive improvement, as is often seen as part of their core function?

Veena Raleigh presented her unique longitudinal analysis, looking at trends in the national inpatient survey.  She described how national patient survey hadn’t changed much over 8 years. She also talked about very different levels of performance for different sorts of variables: lowest performing were variables about noise, food, delayed discharges, for example; highest were some of the interpersonal variables such as privacy, dignity, respect and cleanliness. Cleanliness was really the only variable that really improved over time – no doubt in relation to the big policy push on it.

No clear conclusions

For some questions, such as relating to hospital food, the year on year performance was quite erratic. For others performance had declined (waiting for a bed, and delayed discharges for example).  What was certainly true was that it was impossible to draw simple messages about performance over time, and you certainly can’t characterise some organisations as high flyers and others as losers.

So to come back to my original question about how engaged we are as consumers when we are asked for feedback, again and again. Alison Cameron, who is a patient leader, really nailed it when she talked about her perspective on this. She described having “consultation fatigue”, and being “allergic to feedback forms”. She said she could smell a “fake consultation” at 100 paces, where it was simply being used to tick the box that says patients had been involved.

Patients as partners, not sources of data

She admonished the NHS for failure to use the assets of patients as partners, and simply saw them as sources of data: “people can’t imagine we have other skills beyond our healthcare experience”.  Alison reminded us of the reality – for me the difference between asking for feedback on our Amazon packaging, and the reality of asking patients who are ill and receiving care. “Would I recommend my acute mental health inpatient unit? I don’t think so”. She imagines suited men pointing to record levels of patient satisfaction on a pie chart, while day-in day-out, we know bad stuff does go on.

She described the automated text messages sent as one way of collecting the Friends and Family Test – and the experience of a friend who received a cheery text “how did we do today” while on her way home having suffered a miscarriage. She urged the NHS to “get rid of gimmicks and specious feedback loops”, and to remember “the human being behind the data which is mapping our misery”.

All of which points to involving patients more, not less, in authentic ways to help staff to understand what it is like to receive care, and then to work alongside them to find solutions to the problems that they see. Methods like Experience Based Co-design, and Patient and Family Centred Care, which support staff to see care through patients’ eyes, and work alongside patients to make things better.