Online patient feedback offers important insights into the safety and quality of care (2024)

Opinion BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q1243 (Published 11 July 2024) Cite this as: BMJ 2024;386:q1243

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  1. James Munro, chief executive
  1. Care Opinion

Patient feedback is an overlooked source of information, writes James Munro

How useful is online patient feedback? Are patients really telling us anything we need to know about the quality and safety of healthcare, beyond the kindness of staff and the problems they encountered with food and parking?

If you listened to some healthcare staff, you’d be forgiven for thinking that online feedback was a waste of time—or worse. “Things are picked up online but it’s not usually severe … usually people wanting to have a rant,” said one head of patient experience to researchers,1 while a study exploring attitudes in primary care quotes a practice nurse clearly at the end of her tether: “People know the NHS is on its knees and how it is, so don’t sit there slagging and slating, yeah? No, no I can’t bear it.”2

A 2019 survey of medical and nursing staff presents a slightly less negative picture, with around 39% of doctors and 74% of nurses feeling that online patient feedback might be useful in helping the NHS improve services.3 Even so, it’s not exactly a ringing endorsem*nt.

But another study offers a different perspective on patient feedback, suggesting that patients are reporting important things about the safety of care that staff don’t know about or are failing to tackle.4 The study analysed more than 146 000 stories retrieved from Care Opinion, a non-profit feedback platform for health and social care, where I have worked since 2006.5 Stories are submitted to Care Opinion by patients, families, and friends, with the intent that they help improve care.6 After moderation, the stories are published and become available for anyone to use, including for research, teaching, or service improvement.

The researchers used a machine learning model to detect stories that reported safety incidents. Qualitative analysis of the incidents in these stories showed that many were either unobserved or unresolved by staff, with patients apparently posting online as a last resort.4

The researchers found that these patient-reported safety incidents were “significantly predictive of hospital-level mortality.” Alongside this, and still more intriguingly, was the finding that staff reports of safety incidents (via the UK National Reporting and Learning System) were not predictive of hospital-level mortality in the same way. The authors suggested that this might be because organisational culture determines which safety incidents do or don’t get reported by staff. Noting the number of safety concerns that patients and relatives felt had been dismissed or ignored by staff, they went on to argue: “Online patient feedback may reveal hospitals that are poor at detecting and responding to safety incidents.”

Staff blind spots

A poor safety culture is increasingly recognised as a contributor to failings in NHS care. Rob Behrens, the outgoing parliamentary and health service ombudsman in England, wrote that “too often we see the commitment to patient safety in the NHS undermined by a defensive leadership culture,”7 while in her “100 days” report, Henrietta Hughes, the new patient safety commissioner for England, put “culture change” in her top three priorities, noting: “When people voice inconvenient truths, the system turns its back and fails to listen and act.”8

Patients and carers are free of institutional ties and the influence of organisational culture. Their reports are independent and unbiased by any knee-jerk defensiveness. Instead of being dismissed by staff as the aggrieved rantings of the discontented, unsolicited reports on the quality of care from outside an organisation should be given greater weight by staff whose own judgment is inevitably compromised by their insider status.

Patient feedback should be welcomed for the insights it can offer into the quality and safety of healthcare, particularly when it comes to staff blind spots or failings in institutional culture. This conclusion is strengthened by other research showing that online patient feedback is predictive of Care Quality Commission inspection ratings in England.9

Sadly, we are still some way from seeing patient feedback valued as it should be. In some parts of the UK, where policy and leadership have supported a system wide approach to inviting and responding to online patient feedback, there is growing acceptance that this is an important part of fostering a more open, less defensive culture. For example in Scotland, with government support, all territorial health boards now use Care Opinion, as do the five health and social care trusts in Northern Ireland.

In England and Wales, progress is far more uneven, and there are many healthcare providers still apparently content to ignore online feedback completely, or respond in ways which are banal or uncomprehending.10 Despite this, a growing number of healthcare staff are engaging more openly with online feedback and finding, perhaps to their surprise, that there are worthwhile benefits not just for patient safety but also for staff morale, confidence, and pride.11

Footnotes

  • Competing interests: I am a paid full-time employee of Care Opinion (a community interest company), which provides an online patient feedback platform for health and social care services.

  • Provenance: Commissioned; not peer reviewed.

References

    1. Ramsey L,
    2. Lawton R,
    3. Sheard L,
    4. O’Hara J

    . Exploring the sociocultural contexts in which healthcare staff respond to and use online patient feedback in practice: In-depth case studies of three NHS Trusts. Digit Health2022;8:20552076221129085. doi:10.1177/20552076221129085.pmid:36276183

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    1. Montgomery CM,
    2. Powell J,
    3. Mahtani K,
    4. Boylan AM

    . Turning the gaze: Digital patient feedback and the silent pathology of the NHS. Sociol Health Illn2022;44:290-307. doi:10.1111/1467-9566.13419.pmid:34862794

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    1. Atherton H,
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    3. Williams V,
    4. Powell J

    . Online patient feedback: a cross-sectional survey of the attitudes and experiences of United Kingdom health care professionals. J Health Serv Res Policy2019;24:235-44. doi:10.1177/1355819619844540.pmid:31154858

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    1. Gillespie A,
    2. Reader TW

    . Online patient feedback as a safety valve: An automated language analysis of unnoticed and unresolved safety incidents. Risk Anal2022. doi:10.1111/risa.14002.pmid:35945156

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  1. Care Opinion. About Care Opinion. https://www.careopinion.org.uk/info/about

    1. Mazanderani F,
    2. Kirkpatrick SF,
    3. Ziebland S,
    4. Loco*ck L,
    5. Powell J

    . Caring for care: Online feedback in the context of public healthcare services. Soc Sci Med2021;285:114280. doi:10.1016/j.socscimed.2021.114280.pmid:34358947

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  2. Behrens R. A priority for all: Rob Behrens reflects on patient safety in 2023. Parliamentary and Health Service Ombudsman. December 2023. https://www.ombudsman.org.uk/news-and-blog/blog/priority-all-rob-behrens-reflects-patient-safety-2023

  3. Hughes H. 100 days report. Office of the Patient Safety Commissioner for England. Patient Safety Commissioner. February 2024. https://www.patientsafetycommissioner.org.uk/our-reports/100-days-report/

    1. Griffiths A,
    2. Leaver MP

    . Wisdom of patients: predicting the quality of care using aggregated patient feedback. BMJ Qual Saf2018;27:110-8. doi:10.1136/bmjqs-2017-006847.pmid:28971881

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    1. Ramsey L,
    2. Sheard L,
    3. Lawton R,
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    . How do healthcare staff respond to patient experience feedback online? A typology of responses published on Care Opinion. Patient Exp J2019;6. doi:10.35680/2372-0247.1363.

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    4. et al

    . Health service improvement using positive patient feedback: Systematic scoping review. PLoS One2023;18:e0275045. doi:10.1371/journal.pone.0275045.pmid:37796785

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Online patient feedback offers important insights into the safety and quality of care (2024)

FAQs

Online patient feedback offers important insights into the safety and quality of care? ›

Noting the number of safety concerns that patients and relatives felt had been dismissed or ignored by staff, they went on to argue: “Online patient feedback may reveal hospitals that are poor at detecting and responding to safety incidents.”

Why is patient feedback so important? ›

Patient feedback can help identify gaps in services or care that healthcare providers should be aware of. This is particularly important for pinpointing areas where additional resources and support are needed, so it can be added to the patient journey map.

Why quality care and patient safety are important in the healthcare system? ›

Improving quality of care goes hand in hand with patient safety. Providing the best possible care isn't just about preventing errors; it's about ensuring the right patient gets the right care at the right time. It involves all aspects of the healthcare delivery process, from initial diagnosis to the final treatment.

Why feedback is important in care setting? ›

Care feedback is essential for quality improvement and accountability in health and social care. From empowering people drawing on support to pushing positive changes, feedback plays an important role in shaping the delivery of care in a service.

How does feedback help in healthcare? ›

First and foremost, it tells you how your patients perceive your practice and the care you provide. This can help you improve your quality of care and patient satisfaction — which ultimately aids with acquiring new patients and retaining current ones. Patient visits are multifaceted, and every facet is important.

How can we use patient feedback more effectively to improve care? ›

If patients report more problems with certain aspects of the patient journey, it may be appropriate to concentrate on these areas. This could include the admission process or arrangements for leaving hospital, for example. Changes in performance can be identified when surveys are repeated.

What is feedback and why is it important? ›

Feedback is crucial in two-way communication to ensure both sides are on the same page and can prevent misunderstandings or confusion. It also strengthens the bonds of trust and rapport between the sender and the recipient. Giving constructive feedback on communication is a crucial leadership trait.

How to improve safety and quality of care? ›

Five ways to improve patient safety in hospitals
  1. Move away from paper. Paper is still the most common way of recording information about tasks in hospitals. ...
  2. Implement effective task management. ...
  3. Streamline communications between colleagues. ...
  4. Improve patient flow. ...
  5. Provide safer systems.
Mar 25, 2021

What is the importance of patient care and safety? ›

Patient safety plays a significant role in the healthcare industry since it directly affects patients' well-being and trust. Providing a safe environment for patients is a primary goal for healthcare organizations all around the world.

Why is quality and safety more important? ›

In any organization, both safety and quality are equally important and go hand-in-hand. Although a business can opt to produce a quality product without establishing robust safety management, the price to pay is high in case of a disaster.

Why is feedback important for safety? ›

Listening and responding to feedback from employees should be an essential part of every organization's health and safety process. Employees can provide unique insights and make innovative suggestions that can enhance your organizational health and safety.

Why is feedback important in quality control? ›

Feedback is essential for any production and quality control process, as it helps you identify and correct errors, improve efficiency, and satisfy customer expectations.

What is the importance of correct feedback? ›

At its core, feedback provides people with valuable insights into their performance, behavior, and impact. Whether it's praise for a job well done or constructive criticism aimed at improvement, feedback offers a roadmap for growth. Enhanced performance.

What are the benefits of patient feedback? ›

Patient feedback is a powerful way to collect patient insights at various points of the patient journey and use them to drive quality improvement, enhance patient safety, and foster a culture of continuous care and improvement.

What are the key benefits of feedback? ›

KEY BENEFITS OF FEEDBACK

Constructive feedback provides the opportunity for ongoing performance improvement. It prevents performance from going off track or becoming misaligned, wasting valuable time, energy or resources. Appreciative feedback and recognition builds someone's sense of being valued.

What is an example of positive feedback in healthcare? ›

Some examples of positive feedback include: “Would like to say a massive thank you to the nurse who saw me for making me feel so at ease, I was so nervous and emotional, and she calmed me.” “Friendly helpful and reassuring staff, good care from doctors and health care staff.”

How important is client feedback? ›

Customer feedback helps you improve your products and services. Customers sometimes give feedback that mentions a negative experience they've had. While it may seem disheartening, this feedback actually helps you improve your products and business operations, especially if you use it to make changes.

Why is feedback important for personal effectiveness? ›

Effective feedback:

Builds relationships/trust and support. Clarifies expectations, performance goals and objectives. Helps us to see the impact of our actions on others. Invites self-reflection and enriches personal development.

Why is feedback important in therapeutic communication? ›

Feedback plays a significant role in the therapeutic relationship. It can be used to improve outcomes of psychotherapy by inviting and using feedback from patients as a clinical skill 1. Mental health clinicians strive to evoke genuine feedback from clients by engendering trust, comfort, and collaboration 2.

Why is it important to review patient records? ›

Hospitals and other health systems utilize medical record review to identify instances of harm to patients, ensure quality improvement and thereby enhance patient safety.

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