My Experience of Patient Opinion - Some Reflections

In January 2013 my portfolio at work changed to include the Feedback and Complaints Team at NHS Ayrshire and Arran.   This included responsibility for developing Patient Opinion in support of the Board’s commitment to support continuous improvement in the quality of services.   In 2011 I had attended a presentation by Jim Conway, from the Institute of Healthcare Improvement, and noted that there were opportunities to improve contact and involvement with people who had been affected by instances of avoidable harm.  See http://vimeo.com/14122320 for one of his presentations.

With the support of the Board, tests of change were carried out in relation to changing the way in which people were involved in dialogue about harm, offering personal apology when needed, engaging with people’s pain and distress; and involving them in the quest to learn and improve our healthcare system more generally.   This resulted in significant learning for me, colleagues and for the organisation – particularly in relation to the importance of nurturing a culture where reaching out personally in this way was supported.  

Some experienced the tests of change as tantamount to minimising the personal impact of events on staff.   This resulted in the identification of specific observations about culture and leadership in some areas, which in turn has lead to a programme to improve organisational culture and NHS Ayrshire and Arran now having a very reliable process for the systematic review of significant adverse events.  

As a practitioner psychologist much of my clinical career has, by definition and as you would expect, been spent understanding the personal meaning of events, interactions and experiences that are so often at the heart of understanding the origins of psychological symptoms; as well as enabling people to identify how best to make changes that unlock potential, reduce distress or address problems.

I have also spent many hours reflecting on the personal meaning of the tests of change that were being introduced to better meet the needs of the people who were involved with instances of harm.  I learned first hand that there are/were many people in the NHS who are frightened of transparency.  This in turn made it difficult for them to embrace new review processes or to appreciate the benefits being reported by people affected.

I learned though that our responses as public servants have significant potential to restore, engender (or regrettably in some instances), rupture the sense of trust the people have in us and the work of our organisations.    When things have not been experienced the way services would have wished them to be, Patient Opinion has the power to restore trust when this has been weakened, to provide a supportive connection for people who have been let down and to showcase dialogue focused on apology, restoration, learning and improvement through what I believe is a wonderful website/organisation.

Since being involved with Patient Opinion, I have been encouraged by the numbers of people within NHS Ayrshire and Arran who have shown an interest in the approach that has been taken to responses.  Colleagues from across the UK have also made contact to provide me feedback on the responses.    Within my own organisation, I think it has helped with wider work to support transparency, empowering and enabling people to engage personally when things go wrong – talking to ‘person to person’, supporting personal connections when people wish to establish these and, importantly as part of the wider movement to support person centred, respectful and collaboratively designed services, demonstrating what ‘people powered health care’ might look like.  People who are not sure about posting on the site have shared their positive experiences of doing so.

It has not been difficult to set aside half an hour each day to review what people have said, stopping to think about what it took to do so or reflecting on the feedback that has been provided. 

My personal checklist prompts me to consider how I would feel if it was a loved one’s feedback I was reading – and how I would expect a representative of the organisation to communicate with them. I would not want a standardised response that provides the email of the complaints team, or a bland statement that says the issues will be looked into (in the case of critical comment). When the comments are positive, a similarly personalised response would be what I would want to see.  Patient Opinion provides the opportunity for people to receive such responses directly from staff.   

There’s a wider audience too – just a couple of weeks ago I received a letter from someone who had been reading responses on the site.  He had not been able to ‘navigate’ the complexities of the system to find out the result of an important clinical test and, having seen some of the commitments given to Patient Opinion users asked if I could help.   While I would have preferred that he had not had to have weeks of concern about why he had not heard from our staff,  I was delighted to be able to arrange for the result to be issued to him; noting the ‘defect’ in the system that his experience identified.

Patient Opinion is providing us with a mechanism of being more accessible to the people who use services and, as someone who is convinced transparency is what accelerates improvement, does so in a way that everyone can read what commitments are being made to respond.

So, my closing words of advice to colleagues supporting NHS Ayrshire and Arran’s work on Patient Opinion are:

• Respond as soon as you can
• Offer personal contact
• Be yourself
• Take a moment to consider the personal meaning of the experience to the person who has posted – what can you do to show that you understand, respect and will respond to that
• If feedback is about a known problem then say so and explain what is being done to change things
• Don’t be concerned about being ‘too honest’ – it’s the key to respectful and restorative relationships with people who have been let down by our system
• Remember that there are many other people reading what is written – every response is an opportunity to demonstrate how improvements in healthcare quality depend on the development of collaborative, ongoing and meaningful relationships with the people we serve.

I write this, my first Patient Opinion blog, the day before I move to work as Divisional Clinical Lead in the Planning and Quality Division of the Quality Unit with Scottish Government.   I will be working closely with policy leads across a range of areas, providing clinical leadership across the Person Centred, Clinical Priorities,  Planning and Quality Teams.    I am delighted that this will includes the way in which NHSScotland can benefit from the work of Patient Opinion, providing a chance for some of my reflections, insights and experiences in Ayrshire and Arran to inform work of colleagues across other Boards.  I am also very much looking forward to discussing how other NHS Boards have been using Patient Opinion to support the national aims and focus for high quality health and social care….. and sharing reflections from a different perspective in due course.

Craig White wrote this blog in his final week as Assistant Director, Executive Nurse Directorate, NHS Ayrshire and Arran.  He is now Divisional Clinical Lead, within the Quality Unit, Director General – Health and Social Care, Scottish Government.  Email: craig.white@scotland.gsi.gov.uk

Acknowledgements

Thanks to Gina, Natalie, Paul, James and all at Patient Opinion for their support as we have explored how best to use Patient Opinion to help with our work.  

Sincere thanks too to NHS Ayrshire and Arran e-Health team for supporting testing work re alerts and, of course, all who have used the site, spoken with me and with colleagues following postings and those who have pasted links on Twitter.