Feedback - Can Patient Opinion help inform consultant appraisal and revalidation?

Ian Reeves (@iangarethreeves) is a Consultant Physician in Geriatric Medicine with NHS Greater Glasgow and Clyde and Professional Advisor to the SPSO (Scottish Public Service Ombudsman).  Here he shares his thoughts about using feedback on PO in the appraisal process.

'Feedback' - It's what we give medical students about their exams, and patients about their diabetes blood results.

The idea that this process could be reversed, and patients should give feedback to their doctors was relatively new, and not universally welcomed!

This changed since the GMC introduced revalidation in 2012. This mandates doctors, once every 5 years, to seek feedback from patients and colleagues and discuss this in their appraisal interview.

This was also included in guidance from the GMC in 2013 which stated

You must take part in systems of quality assurance and quality improvement to promote patient safety. This includes'.....'reviewing patient feedback where it is available.'

The current process has two parts. A paper based questionnaire for patients to complete, and an online feedback form for feedback from colleagues. Both of these keep the respondent anonymous.

I've just done my appraisal with these two processes and I also used Patient Opinion for the first time, and I've reflected on this and the difference between them.

 Collecting feedback

For my patient feedback I gave the staff at the clinic feedback forms, a clipboard and pen. I asked them to give a form to each patient after they left me. These were then placed in an envelope (already addressed to specific staff who collate these) and sent at the end of each clinic. From the forms left at the end it was possible to work out how many were done each clinic and keep going until they were all used. I explained to patients at the end of our consultation that they would be asked to do this.

Before my appraisal I was emailed the results of this for me to reflect on and discuss with my appraiser.

 My 'results' are shown below:

I was relieved that there wasn’t any unduly negative feedback. This was a real fear of doctors when this was introduced. Like the skim reading of a school report before presenting it to parents, I felt there wasn’t anything to 'fear' from showing this to my appraiser.

After the relief settled - a nagging doubt arose that wouldn't stop bouncing around in my head.

If this feedback is meant to drive improvement in how I work, what information was there from those patients who had made the most negative comments? This is where I realised the weakness of this process - there wasn't any narrative to help me identify what I should improve.

Someone said I was only 'fair' at 'making them feel at ease'. Hmmm..what did I do differently for that patient - or more importantly - what should I do differently if I see them next time?

Without any narrative, I don’t know.

At the same time I had used Patient Opinion after learning about it from Dorothy Armstrong (@dorothy_DAprof), a fellow adviser at the Scottish Public Services Ombudsman.

I gave out some of the pre-printed feedback forms to patients at the clinics and watched the replies appear on the Patient Opinion Website.

https://www.patientopinion.org.uk/opinions/141439

The narrative from this one included suggested something we could improve about our service, not just a rating from 'poor' to 'excellent'. It highlighted that although some parts of our process worked well, there was a real frustration that other parts hadn’t. I used the information to help improve this aspect of his care, and to try and improve it for others in the future.

This was different - and I found this a much more useful form of feedback. It felt like a useful comment from a real person, not just a rating on a scale.

If I could choose, i’d prefer to collect all my patient feedback this way.

If you are about to have an appraisal, and need a method of feedback, I’d recommend trying Patient Opinion. One response like this gave me more to reflect on, discuss, and improve, than the entire 'formal' feedback process of 21 forms with a rating scale.