Is patient feedback an effective means of achieving change in the modern

Patient feedback takes many forms and can drive meaningful change at all levels of the NHS… …but any tool needs to be used appropriately… …and we should be reasonable in our expectations. Picker Institute Europe2 Introduction

“Patient feedback is an ineffective means of achieving change in the modern NHS.” Picker Institute Europe 7 What constitutes ‘effectiveness’? Big changes in national policy? Systematic changes in practice? Local innovation? One-to-one cases of patient care? What change are we looking for? Better experiences of care? Improved outcomes? Better safety? Better financial control? Is there a (homogenous) ‘modern NHS’? Across sectors (primary care, acute, etc) Within sectors (different organisations, teams, etc) What is patient feedback? Surveys Friends and Family Test Patient Opinion Twitter, Facebook, etc

The King’s Fund (2013). An alternative guide to the new NHS in England. Available from: 4

Photo credit: - used under Creative Commons CC-BY-NC-SA 2.0 5

Better staff experience 1 Higher clinical effectiveness & better patient safety 2 Lower complication rates 3 Reduced likelihood of adverse drug events 4 But also distinct: “Although there are associations between clinical quality and measures of patient experience, the 2 domains … remain predominately distinct” 5 1 Raleigh, V. S., Hussey, D., Seccombe, I., & Qi, R. (2009). Do associations between staff and inpatient feedback have the potential for improving patient experience? An analysis of surveys in NHS acute trusts in England. Quality and Safety in Health Care, 18(5), 347 – Doyle, C., Lennox, L., & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open, 3(1). 3 Black, N. (2014). Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery. BMJ Qual Saf, 23(7), Forster, A. J., Murff, H. J., Peterson, J. F., Gandhi, T. K., & Bates, D. W. (2005). Adverse Drug Events Occurring Following Hospital Discharge. Journal of General Internal Medicine, 20(4), 317– Llanwarne, N. R., Abel, G. A., Elliott, M. N., Paddison, C. A. M., Lyratzopoulos, G., Campbell, J. L., & Roland, M. (2013). Relationship Between Clinical Quality and Patient Experience: Analysis of Data From the English Quality and Outcomes Framework and the National GP Patient Survey. The Annals of Family Medicine, 11(5), 467– Patient experience is related to…

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9 Organisations need to be listening

Kidd, S. (2016 March 29) Using Social Media To Share Patient Opinion With Staff. Blog post available at

NHS England (2016 March 18). Friends and Family Test Awards – Best Other Winner. YouTube: Friends and Family Test

Raleigh, V., Thompson, J., Jabbal, J., Graham, C., Sizmur, S., & Coulter, A. (2015 November). Patients’ experiences of using hospital services: an analysis of trends in inpatient surveys in NHS acute trusts in England, The King’s Fund, London UK National surveys

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Picker Institute Europe14 Local improvement

Patient feedback can drive meaningful change Success stories are out there and verify this… but: Potential of patient feedback not yet fully realised – specific challenges include: Mismatch between methods & aims Disconnect between measurement & use of data Differences across sectors Lack of overall strategy on person-centredness Picker Institute Europe15 Conclusions

Shaller, D. (2007) Patient-centered care: what does it take? Retrieved from 16 Treat feedback as part of an overall person-centred care strategy

Feedback method StrengthsWeaknessesMain audiences Friends and Family Test Immediacy; wide distribution; free text comments Not a statistical measure; little to no comparability Front line teams User generated content (ie Patient Opinion, Twitter, Facebook, etc) Allows direct conversations with individual patients Difficult to (meaningfully) generalise data PALS; patient experience leads Local (sub organisational) surveys Statistical comparisons w/in organisations May limit external comparability Ward/site managers; front line National surveysRobust, generalizable, comparable data Slower to produce; limited granularity Management; boards; policy makers; etc Balance strengths/weaknesses of methods

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