Discover Portal

patient feedback

NIHR Signal Online patient feedback is mostly positive — but is not being used effectively

Published on 15 January 2020

doi: 10.3310/signal-000861

People are increasingly reading online feedback from other patients to gauge service quality but fewer people go online to write feedback themselves. Health organisations and professionals are not currently effective at using this feedback to improve services.

These findings come from an NIHR-funded study which used five research streams to provide an overview of online patient feedback in the NHS.

Healthcare professionals rarely encourage online patient feedback and may be sceptical about it. However, the majority of online feedback from patients is positive. NHS trusts do not monitor all online feedback channels, and hospital staff are often unsure whose responsibility it is to respond.

NHS England has committed to using online feedback as part of its vision for a digital NHS. This study highlights some key areas for improvement for organisations to help them make better use of online patient feedback. Importantly, the study suggests that managers could usefully review the infrastructure and processes for responding to feedback if they have not already done so.

Share your views on the research.

Why was this study needed?

Online customer feedback is now routinely used by many industries, but the NHS has not yet effectively harnessed this feedback to help make improvements.

While there has been much work around patient-centred care and patient experience, there is a lack of clear direction about how to deal with patient feedback. As patients increasingly go online to express views, care providers risk missing concerns if they are not prepared for listening. The lack of an effective response to patient feedback has been highlighted by recent high-profile investigations into failures within the NHS, including in Mid-Staffordshire.

Doctors have expressed doubts about online patient feedback, questioning its validity and representativeness, as well as raising concerns around professional relationships with patients, confidentiality and the difficulties they face responding to online feedback.

This NIHR-funded study (the INQUIRE study) aimed to take a broad look at the use of online patient feedback in the NHS, to provide evidence about how it might be improved.

What did this study do?

Researchers reviewed 78 studies (up to January 2018) from the USA, UK, Germany and elsewhere. They consulted 15 healthcare stakeholders from the UK with online feedback experience to identify the questions for their analysis.

A representative sample from the UK (2,036 participants) was surveyed face-to-face with a public questionnaire survey.

An online questionnaire was also completed by 1,001 registered doctors and 749 nurses and midwives.

Semi-structured interviews were conducted with 37 people who had read others’ healthcare service reviews or provided their own.

Organisational case studies were carried out at four NHS trust sites, including two mental health and community trusts, one large acute trust and one specialist trust. A researcher spent 6 to 10 weeks within each trust.

What did it find?

  • The survey of the general public found that 90% were internet users. In the last year, 42% of these had read online healthcare feedback and 8% had provided feedback. Those who read feedback were more likely to be younger, female, with a higher income, and more frequent internet users. More frequent internet users were also more likely to provide feedback.
  • The most frequent reasons for reading feedback were: finding out about a drug, treatment or test; and helping to choose a treatment or provider. Motivations for writing feedback were to inform other patients, praise a service or improve standards of services. Almost all respondents (94%) said they had never been asked to provide feedback by their healthcare provider.
  • The survey of doctors and nurses found that: 28% of doctors and 21% of nurses were aware that patients or carers had provided online feedback about an episode of care in which they were involved, and 21% of doctors and 11% of nurses had experienced online feedback about them as an individual practitioner. Doctors were more likely than nurses to believe that online feedback is unrepresentative and mostly negative. Concerns were expressed about representativeness and a lack of guidance on how to use feedback.
  • The majority of online feedback was positive. Individuals often had multiple motivations for giving online feedback, including the desire to engage in a ‘conversation’ to improve healthcare services, support staff and other patients. The researchers suggested that it is appropriate and helpful to think of online feedback as a way to start a conversation and for patients to show their care for the NHS.
  • For NHS trusts, online patient feedback was found to be gradually changing how trusts are held accountable and to whom. However, trusts may lack the infrastructure to address multiple channels and increasing amounts of online feedback, and to ensure responses are swift and publicly visible.

What does current guidance say on this issue?

NICE’s guideline on patient experience (2012) states that patients should be encouraged to give feedback on the care that they receive and that clinicians should respond to any feedback given. The guideline does not outline specifically how online patient feedback should be addressed.

The government have outlined a vision for the future of digital healthcare in their policy paper ‘The future of healthcare: our vision for digital, data, and technology in health and care’ (2018), which notes the need for improved online services and other technology infrastructure in the NHS and to build an open culture where feedback is welcomed.

What are the implications?

These results highlight a lack of organisational preparedness in dealing with online patient feedback.

The government has an ambitious digital health agenda with the idea of a patient as a digitally sophisticated health consumer at its core. Service providers will need to develop more robust infrastructure and processes for engaging with online patient feedback to make this a reality.

The Point of Care Foundation has developed a practical guide based on this study’s findings, to help teams in the NHS to use online patient feedback to improve quality in healthcare.

Citation and Funding

Powell J, Atherton H, Williams V et al. Using online patient feedback to improve NHS services: the INQUIRE multimethod study. Health Serv Deliv Res. 2019;7(38).

This project was funded by the NIHR Health Services and Delivery Research programme (project number HS&DR 14/04/48).

Bibliography

DHSC. The future of healthcare: our vision for digital, data and technology in health and care. London: Department of Health and Social Care; 2018.

NICE. Patient experience in adult NHS services: improving the experience of care for people using adult NHS services. CG138. London: National Institute for Health and Care Excellence; 2012.

The Point of Care Foundation. Using online patient feedback to improve care. London: The Point of Care Foundation; 2019.

Why was this study needed?

Online customer feedback is now routinely used by many industries, but the NHS has not yet effectively harnessed this feedback to help make improvements.

While there has been much work around patient-centred care and patient experience, there is a lack of clear direction about how to deal with patient feedback. As patients increasingly go online to express views, care providers risk missing concerns if they are not prepared for listening. The lack of an effective response to patient feedback has been highlighted by recent high-profile investigations into failures within the NHS, including in Mid-Staffordshire.

Doctors have expressed doubts about online patient feedback, questioning its validity and representativeness, as well as raising concerns around professional relationships with patients, confidentiality and the difficulties they face responding to online feedback.

This NIHR-funded study (the INQUIRE study) aimed to take a broad look at the use of online patient feedback in the NHS, to provide evidence about how it might be improved.

What did this study do?

Researchers reviewed 78 studies (up to January 2018) from the USA, UK, Germany and elsewhere. They consulted 15 healthcare stakeholders from the UK with online feedback experience to identify the questions for their analysis.

A representative sample from the UK (2,036 participants) was surveyed face-to-face with a public questionnaire survey.

An online questionnaire was also completed by 1,001 registered doctors and 749 nurses and midwives.

Semi-structured interviews were conducted with 37 people who had read others’ healthcare service reviews or provided their own.

Organisational case studies were carried out at four NHS trust sites, including two mental health and community trusts, one large acute trust and one specialist trust. A researcher spent 6 to 10 weeks within each trust.

What did it find?

  • The survey of the general public found that 90% were internet users. In the last year, 42% of these had read online healthcare feedback and 8% had provided feedback. Those who read feedback were more likely to be younger, female, with a higher income, and more frequent internet users. More frequent internet users were also more likely to provide feedback.
  • The most frequent reasons for reading feedback were: finding out about a drug, treatment or test; and helping to choose a treatment or provider. Motivations for writing feedback were to inform other patients, praise a service or improve standards of services. Almost all respondents (94%) said they had never been asked to provide feedback by their healthcare provider.
  • The survey of doctors and nurses found that: 28% of doctors and 21% of nurses were aware that patients or carers had provided online feedback about an episode of care in which they were involved, and 21% of doctors and 11% of nurses had experienced online feedback about them as an individual practitioner. Doctors were more likely than nurses to believe that online feedback is unrepresentative and mostly negative. Concerns were expressed about representativeness and a lack of guidance on how to use feedback.
  • The majority of online feedback was positive. Individuals often had multiple motivations for giving online feedback, including the desire to engage in a ‘conversation’ to improve healthcare services, support staff and other patients. The researchers suggested that it is appropriate and helpful to think of online feedback as a way to start a conversation and for patients to show their care for the NHS.
  • For NHS trusts, online patient feedback was found to be gradually changing how trusts are held accountable and to whom. However, trusts may lack the infrastructure to address multiple channels and increasing amounts of online feedback, and to ensure responses are swift and publicly visible.

What does current guidance say on this issue?

NICE’s guideline on patient experience (2012) states that patients should be encouraged to give feedback on the care that they receive and that clinicians should respond to any feedback given. The guideline does not outline specifically how online patient feedback should be addressed.

The government have outlined a vision for the future of digital healthcare in their policy paper ‘The future of healthcare: our vision for digital, data, and technology in health and care’ (2018), which notes the need for improved online services and other technology infrastructure in the NHS and to build an open culture where feedback is welcomed.

What are the implications?

These results highlight a lack of organisational preparedness in dealing with online patient feedback.

The government has an ambitious digital health agenda with the idea of a patient as a digitally sophisticated health consumer at its core. Service providers will need to develop more robust infrastructure and processes for engaging with online patient feedback to make this a reality.

The Point of Care Foundation has developed a practical guide based on this study’s findings, to help teams in the NHS to use online patient feedback to improve quality in healthcare.

Citation and Funding

Powell J, Atherton H, Williams V et al. Using online patient feedback to improve NHS services: the INQUIRE multimethod study. Health Serv Deliv Res. 2019;7(38).

This project was funded by the NIHR Health Services and Delivery Research programme (project number HS&DR 14/04/48).

Bibliography

DHSC. The future of healthcare: our vision for digital, data and technology in health and care. London: Department of Health and Social Care; 2018.

NICE. Patient experience in adult NHS services: improving the experience of care for people using adult NHS services. CG138. London: National Institute for Health and Care Excellence; 2012.

The Point of Care Foundation. Using online patient feedback to improve care. London: The Point of Care Foundation; 2019.

Using online patient feedback to improve NHS services: the INQUIRE multimethod study

Published on 30 October 2019

Powell J, Atherton H, Williams V, Mazanderani F, Dudhwala F, Woolgar S et al.

Health Services and Delivery Research Volume 7 Issue 38 , 2019

Background: Online customer feedback has become routine in many industries, but it has yet to be harnessed for service improvement in health care. Objectives: To identify the current evidence on online patient feedback; to identify public and health professional attitudes and behaviour in relation to online patient feedback; to explore the experiences of patients in providing online feedback to the NHS; and to examine the practices and processes of online patient feedback within NHS trusts. Design: A multimethod programme of five studies: (1) evidence synthesis and stakeholder consultation; (2) questionnaire survey of the public; (3) qualitative study of patients’ and carers’ experiences of creating and using online comment; (4) questionnaire surveys and a focus group of health-care professionals; and (5) ethnographic organisational case studies with four NHS secondary care provider organisations. Setting: The UK. Methods: We searched bibliographic databases and conducted hand-searches to January 2018. Synthesis was guided by themes arising from consultation with 15 stakeholders. We conducted a face-to-face survey of a representative sample of the UK population (n = 2036) and 37 purposively sampled qualitative semistructured interviews with people with experience of online feedback. We conducted online surveys of 1001 quota-sampled doctors and 749 nurses or midwives, and a focus group with five allied health professionals. We conducted ethnographic case studies at four NHS trusts, with a researcher spending 6–10 weeks at each site. Results: Many people (42% of internet users in the general population) read online feedback from other patients. Fewer people (8%) write online feedback, but when they do one of their main reasons is to give praise. Most online feedback is positive in its tone and people describe caring about the NHS and wanting to help it (‘caring for care’). They also want their feedback to elicit a response as part of a conversation. DOI: 10.3310/hsdr07380 HEALTH SERVICES AND DELIVERY RESEARCH 2019 VOL. 7 NO. 38 © Queen’s Printer and Controller of HMSO 2019. This work was produced by Powell et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. vii Many professionals, especially doctors, are cautious about online feedback, believing it to be mainly critical and unrepresentative, and rarely encourage it. From a NHS trust perspective, online patient feedback is creating new forms of response-ability (organisations needing the infrastructure to address multiple channels and increasing amounts of online feedback) and responsivity (ensuring responses are swift and publicly visible). Limitations: This work provides only a cross-sectional snapshot of a fast-emerging phenomenon. Questionnaire surveys can be limited by response bias. The quota sample of doctors and volunteer sample of nurses may not be representative. The ethnographic work was limited in its interrogation of differences between sites. Conclusions: Providing and using online feedback are becoming more common for patients who are often motivated to give praise and to help the NHS improve, but health organisations and professionals are cautious and not fully prepared to use online feedback for service improvement. We identified several disconnections between patient motivations and staff and organisational perspectives, which will need to be resolved if NHS services are to engage with this source of constructive criticism and commentary from patients. Future work: Intervention studies could measure online feedback as an intervention for service improvement and longitudinal studies could examine use over time, including unanticipated consequences. Content analyses could look for new knowledge on specific tests or treatments. Methodological work is needed to identify the best approaches to analysing feedback.

Expert commentary

This extensive mixed-methods study has illuminated the contentious issue of online patient feedback.

Many clinicians may be surprised by the finding that the main motivation for patients who provide online feedback is to support the healthcare service, through either praise or a desire to help the service improve. What is less surprising is that, overall, healthcare providers lack the appropriate infrastructure to make good use of this feedback.

The findings of this study suggest that healthcare organisations could benefit from judicious engagement with online feedback, using it as one tool among many in a cycle of continuous quality improvement.

Elizabeth Murray, GP, Professor of eHealth and Primary Care, Co-Director of the eHealth Unit and Head of the Research Department of Primary Care and Population Health, University College London

The commentator declares no conflicting interests