On 7th April, myself and Claire Marsh attended a patient feedback symposium held at Exeter university, organised by HSRUK. It was great to get the chance to hear what other researchers in this field are up to and showed there is now a critical mass of people from academia, policy and practice interested in this issue. It also gave us a chance to meet up again with other people who are working on closely related projects in the patient feedback field. I outline some of the presentations which I found particularly pertinent and what the overall take home message of the day was for me.
Sue Ziebland from the University of Oxford set the audience up for the day by outlining a brief history of where the patient experience movement has arisen from, drawing on notions of patient empowerment but also the rise of individualism and patients as consumers.
Of particular interest to many candidates, was the debate during the mid-morning slot – “Patient feedback is an ineffective means of achieving change in the modern NHS” – with arguments for (Jenni Burt, University of Cambridge) and against (Chris Graham, Picker Institute). Jenni had the unenviable task of trying to argue for this motion yet it was clear from a show of hands in the room that most of the audience was against it. Indeed, Jenni ended up changing the wording of the motion to more closely fit her opinion (!) which was that patient feedback is currently an ineffective means of meaningful change.
After lunch, there were several interesting presentations based on empirical research studies. Jenny Newbould from the University of Cambridge/RAND Europe gave a fascinating presentation about “the tick and the talk” – the differences (and sometimes contradictions) between how patients rate their healthcare in surveys (“the tick”) but how the same experience can be described as quite different when patients are asked elaborate more fully on their experiences (“the talk”). This most often takes the form of patients attributing a high rating their GP or healthcare professional via survey method whilst parts of the consultation were unsatisfactory, when patients were elicited to discuss this.
Sue Richards from the University of Exeter gave an intriguing talk about patient feedback regarding out of hours GP services. I was struck by one of Sue’s findings – patients often fed back about their whole experience (involving 111, A&E and the OOH GP) but yet commissioners seemed disinterested in the patient’s feedback of their journey, largely only being interested in feedback pertaining to GP services. It is difficult for patients to make this distinction as they see their experience as being related to their whole journey/ contact with the healthcare system. In my opinion, this has implications for the collection of feedback from other parts of the healthcare system, such as when patients are asked about their stay on a certain hospital ward but they may also draw on their experience of the ambulance service, A&E and community services upon discharge. How do we allow for the holistic journey of the patient through the healthcare system when not all parties involved may want to see or act upon the feedback given?
Martin Roland from the University of Cambridge rounded off the day in the final keynote speech asking whether patient feedback is an effective tool for quality improvement. One of the points he made is that patient feedback is not like customer feedback in other industries. By and large, the NHS does not lose ‘unhappy customers’ to a competing retailer! Current ways in which NHS organisations/ staff deal with and respond to patient feedback could be viewed as poor and insufficient and how to take this forward is essentially the elephant in the living room.
A key message coming through from many of the presentations is that it is now uniformly agreed that obtaining patient feedback is an important activity to undertake. Nearly everyone seemed to be in agreement about this. People were willing to discuss their paradigmatic positions/ differences on whether quantitative or qualitative methods were more useful at effectively capturing patient feedback. From the conversations I was involved in, I got the sense that people believe that both methods working together to elicit the patient voice is what is needed. I was particularly struck by how a main theme – as I saw it – arising from the group of presentations was around the large gap in our collective knowledge between how organisations collect feedback and then how this is practically translated into improvements and change to healthcare. This seems to be the missing piece of the puzzle both for healthcare staff, NHS organisations and academics interested in this area.