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What do professionals think about feedback?

The attitudes and experiences of healthcare professionals have a huge influence on how quickly and successfully new initiatives are introduced in healthcare settings. We felt it was important to understand their views and find out how healthcare professionals currently use and experience online feedback.

To explore professionals’ attitudes, behaviours and experiences, we carried out surveys of 1,001 UK doctors and 749 nurses and midwives. We also held a focus group with allied health professionals from an NHS trust.

From our own findings and other work, we know that many professionals feel negatively towards online feedback. A large number of professionals believe it is unrepresentative, and many question its value for improving health services. Nurses tend to feel more positively than doctors about online feedback being a useful tool for improving healthcare quality. We also found that hospital-based professionals viewed online feedback more positively than those based in the community.

Awareness of online feedback

Online feedback is potentially most useful when it facilitates a two-way interaction between patients and professionals: many patients told us they wanted their feedback to form part of a conversation. The role of digital technologies is to facilitate that conversation. Yet most doctors and nurses we surveyed didn’t actually know when feedback had been given about an episode of care they were involved in.

Just over one-fifth (20.5 per cent) of doctors and 11.1 per cent of nurses had seen online feedback written about themselves individually. Around half of nurses and 42.3 per cent of doctors did not know if patients had ever posted feedback about them. Our focus group with allied health professionals found similar experiences. Many healthcare professionals felt that organisational communication about online feedback was poor: online feedback ended with the organisation, and many were unsure whether it was directed at themselves (as individuals) or whether it was meant to reach them at all.

I would never even have known it existed had a colleague not pointed it out to me.

Allied health professional

This lack of awareness among staff is a problem, given the need to not only capture, but to respond and act on, the specific experiences of patients.

Usefulness of online feedback

When it comes to the usefulness of online patient feedback, we know there is a big difference between the attitudes of doctors and those of nurses.

The majority of doctors were sceptical about the value of online feedback for improving quality of care. Fewer than half the doctors we surveyed agreed that online feedback on experiences of healthcare was useful for improving services. However, nurses were more optimistic, with almost three-quarters who we surveyed feeling that online patient feedback was useful for improving services. Nurses were also more positive than doctors about the usefulness of social media feedback for improving healthcare quality.

The nature of online feedback

Many professionals believe most online feedback is negative, even though studies show most feedback is in fact positive. More than half of doctors believe this to be the case, while fewer nurses do so. We also found that community-based healthcare professionals were more likely than hospital-based professionals to think that online feedback is generally negative.

Many healthcare professionals felt that the anonymity of online feedback might encourage people to write posts that were more negative or aggressive than feedback gathered in other ways. For this reason, many believed online feedback should be moderated or regulated, to prevent and remove intentionally offensive posts from internet trolls.

Concerns about patients’ confidentiality

We found that professionals worry about patient confidentiality. They felt that directly responding to patients’ comments risked breaking clinical confidentiality – particularly on social media sites where both patients and professionals could be identified. They felt that responses which explained circumstances and added context could risk breaking confidentiality too. Some of the doctors who took part in our survey felt that confidentiality procedures stopped them directly responding to online patient feedback.

Changes resulting from feedback

For online feedback to make a difference, it needs to be not only captured, but also acted on. Because of this, we wanted to know whether professionals were making changes to their practice as a result of the feedback that their patients post online.

Most doctors told us that they did not make any changes to their practice. This is unsurprising given that most doctors were sceptical about the value of online feedback for improving healthcare quality. Nurses, who were more positive about its usefulness, were also more likely to change their practice following feedback.

Encouraging feedback from patients

We also felt it was important to know whether professionals were actually encouraging patients to leave feedback online. Although more and more patients were already using the internet to share experiences of healthcare, our survey showed that most professionals had never encouraged patients or carers to leave online feedback.

It is clear that health professionals have many doubts and are not as engaged with online feedback as they could be. There is scepticism, and as long as providing online feedback remains a marginal and often anonymous activity for many, this makes it easier to ignore or discredit it.  The doubts of professionals will have an impact on the successful embedding of this new source of patient experience data into everyday healthcare.