Negative feedback

The first thing to note – and maybe not without justification after the report this week about GP’s striking off stroppy patients – is how reluctant my mother was to give feedback. She was a bit resassured by the promise of anonymity (though you need to give your email – so will it really stay anonymous?). But her real fear was that the hospital would get its own back next time she ended up in their clutches if you dared to criticise. Other people may share that fear. For what is notable is how few comments people post about their experience. In three and a half years the hospital where my mother was treated has only had 54 comments – running at about 15 a year. Contrast that with the real “tripadvisor” where a hotel I reviewed in Copenhagen had almost 700 in 8 years – almost 6 times as many. Alternatively it may just be that the user profile of a south coast hospital and people who are comfortable sharing their thoughts online barely overlap. But maybe I should be reassured that 4/5 of people recommended the hospital my mother was in. But it may not be a representative selection. On the Trust’s website, there is a choice between making a complaint – by email or phone (to the patient liaison service who point the complaint at the customer relations department) and offering “positive feedback” which takes you to the NHS Choices site. So complaints are siphoned off into secrecy while only positive feedback is invited publicly. The trust does say it reports on complaints in its annual report – but it doesn’t seem to be worth a single freestanding section among all the pictures of smiley nurses and patients and if it is there, it defied my attempts to find it. Nevertheless some people do persevere to give positive – and negative - feedback. But the questions are frustratingly superficial. They start with a binary rating – were you satisfied or not? In any complex operation a simple yes/no is unlikely to suffice. We ended up saying “no view” because our answer was good on some things, poor on others. Three stars, not five, nor none. Would that be so hard? The prompted questions themselves give an interesting insight into NHS priorities. Was it clean (on a six point scale)? Did the staff work together well? Were you involved in decisions about your care? Were you treated with dignity and respect? And was the hospital meeting the commitment on single-sex wards. Nothing about the quality of care. The efficiency of the operation. And impossible to differentiate between wards; services and different members of staff. One of the things you realise in hospital is that there is huge amounts of variation within an institution – one ward good, another substandard.  One nurse caring, another indifferent. Useful feedback would pick that up. Which puts the entire burden on the comment section – divided between “what I liked” and “what could be improved”. But comments of that sort are hard to pick up and pull into a comparative rating.

Some feedback on feedback Make it clear that feedback is welcome – both positive and negative. Add some categories on quality of care and how well run the hospital appeared to be. Allow differentiation between wards and services (and capture all the ones the patient used – my mother was in A and E, coronary care, ortho-geriatric and used the phsysiotherapy and the occupational therapy – and has different views on all of them). Finally – make it easy for the sort of people who are patients to give feedback. When my mother was treated privately in the same hospital she was given a paper feedback form: not on the NHS.  Which is a shame – because it meant they might have missed her major comment – that the NHS treatment was far better than the care she received privately.