Online patient feedback offers important insights into the safety and quality of care
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q1243 (Published 11 July 2024) Cite this as: BMJ 2024;386:q1243
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 endorsement.
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.