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How can we use online patient feedback to improve quality in healthcare?

Emma Hyde and Douglas Findlay Nuffield Department of Primary Care Health Sciences, University of Oxford 19 June 2019

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In 2015, Professor John Powell and a diverse team of researchers and patient representatives embarked on a multimethod study called INQUIRE: Improving NHS Quality Using Internet Ratings and Experiences (funded by the National Institute for Health Research Health Service and Delivery Research Programme). We wanted to understand what online feedback from patients represents, how healthcare staff and patients currently view it, and how healthcare providers could use it to improve the quality of their services.

Patient experience is an increasingly key element of healthcare quality, yet healthcare organisations could do much more to recognise and respond to feedback from patients, families and carers. Likewise, ‘traditional’ forms of feedback such as surveys are struggling to gain good response rates and cannot always be engaged with in ‘real time’. Meanwhile, more and more people are turning to the internet to share their health experiences. Could this be the answer for healthcare?

Used well, online feedback can support a responsive, patient-centred health service that reacts to the needs of its users

Despite the success of online feedback in retail and travel industries – TripAdvisor, Amazon and eBay to name a few popular websites – healthcare is lagging behind. But this is often because healthcare providers have a poor understanding of the strengths and weaknesses of online feedback, and limited knowledge about how to use it for service improvement. There are also unanswered questions about the content of feedback, the people who write it, and their reasons for doing so. These are missed opportunities – used well, online feedback can support a responsive, patient-centred health service that reacts to the needs of its users.

The INQUIRE project

We spoke to experts working in patient experience and reviewed previous research to examine current practice in online feedback. We also developed a public questionnaire to find out who is reading and writing online feedback and why. It was very important to understand what service users think, so we also interviewed patients about their experiences of giving feedback to the NHS. A questionnaire was then developed to find out about the experiences and views of healthcare professionals, and a member of the team observed four NHS trusts to understand the approaches taken to receiving and dealing with online patient feedback. The findings and lessons learned from the INQUIRE project are intended to give the NHS the evidence it needs to engage with and make best use of online feedback alongside other patient experience data.

A journey shaped by patients and the public

Douglas Findlay, lay chair of the Patients, Carers and Public Reference Group, shared his experience of being involved in the INQUIRE project:

“In 2015 I was invited to be involved in a research project funded by the NIHR, so as a relative novice to the field, I googled Professor John Powell, the principal investigator. Little did I realise that this first action was one of the things that this research study would be looking at! With my interest piqued, I attended one of the early meetings and was introduced to many of the researchers and other expert advisors from a number of different specialist areas connected to the project.

“The discussion was wide-ranging and quite intense at times, but as a lay person, I was encouraged to ask questions and on the whole, the terminology used and explanations given were very inclusive. I’m guessing that who to involve had been carefully considered because in hindsight, I cannot think of any area of expertise that wasn’t included somewhere along the pathway of this study. We often didn’t get it right, either in process or practical implementation, but it was encouraging that at each point, we stopped to reflect on how to improve.

“The INQUIRE journey has been a long and fascinating look into the how’s and why’s of ordinary people and healthcare professionals’ use of the internet. This simple action can not only change and sometimes improve our understanding of the service being investigated, but can begin the process of changing the service itself. Whilst the study results throw light on the many and varied reasons for people using the internet ratings and experiences of others, or indeed rating and recording their own experiences, the results also throw up many more questions worthy of further investigation.”

A new resource for healthcare staff

A key objective of the INQUIRE project was to turn the study findings into an online resource to help healthcare staff interpret and respond effectively to online feedback and use it to improve care. We decided to produce this in partnership with The Point of Care Foundation.

The resource incorporates key lessons learned from the research and is aimed at a range of people interested in engaging with and learning more about online patient feedback. For example, managers working in patient experience or quality improvement could use it to help interpret the comments they receive in their organisations. Frontline healthcare staff are often mentioned in reviews from patients and carers, and the resource may help them understand people’s motivations for leaving feedback. But, it is also useful for anyone who uses healthcare services. Seeing how feedback is viewed and used by healthcare providers can highlight ways to provide feedback that might help staff to learn and improve.

We introduce users to the importance of online patient feedback as a valuable health service tool and emphasise what can be learnt from current practice in other industries – for example, the importance of giving patients a visible response. The resource also answers a range of central questions such as how common is it? Who is and isn’t doing it? What do patients, the public and healthcare professionals think about it? And what are the challenges and opportunities for ensuring everyone uses online feedback in the most helpful ways?

For example, we found that many patients give online feedback because they want to start a ‘conversation’ with healthcare providers. If you are looking for more practical advice about making best use of this kind of feedback, our section ‘Applying online feedback to improve care’ offers a number of specific tips and opportunities for optimising use. You will also find the resource is brought to life by video clips and quotes from expert representatives in healthcare and digital health and patients describing their experiences.

The online resource was developed by Eleanor Stanley (Stories for Health), with Joanna Goodrich and Bev Fitzsimons (Point of Care Foundation). Lead responsibility for writing the resource content was taken by Emma Hyde and John Powell (Health Experiences Research Group). Susan Kirkpatrick and Ruth Sanders (Health Experiences Research Group) recorded the video interviews, and Ruth Sanders selected and edited the clips used in the resource. We would also like to thank members of the Patients Carers and Public Reference Group for their feedback.

The new resource is now available. We welcome your feedback: please get in touch on Twitter at @INQUIREUK or @PointofCareFdn. Alternatively, please email

Access the INQUIRE resource

 

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (14/04/48). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.