Working with Care Opinion: a clinical perspective

I first came across Care Opinion (Patient Opinion as it was then) when browsing on social media! As an acute medical consultant, I am very aware that the fast paced, high intensity environment of an acute medical unit can be daunting for a patient and sometimes communication can be found wanting.

So I was fascinated to read stories by patients in similar settings, and this drove me to look at the stories posted about NHS Borders. Two things were immediately obvious: there were not many, and they were not answered by clinicians but by complaints team staff. Although the responses were empathic and caring, they could not relate to the patient’s individual experience and they seemed unlikely to lead to any significant change for future patients.

At that time, NHS Borders read and responded but did not actively seek Care Opinion feedback from patients. When I first became a responder, there were only two other responders in NHS Borders and very little wider organisational awareness of either the process or how valuable this could be in shaping future changes in service. Having recently made some changes to the acute medicine service, I was keen to hear patients’ views on our new service and although we had tried to seek this through paper questionnaires and volunteers, this had not gained a great deal of feedback.

The stories began to trickle in and I was able to respond from a clinician’s perspective

During a Care Opinion learning event I heard about how NHS Fife’s endoscopy team were handing out leaflets to patients inviting them to share their experience of their endoscopy, and so I decided to hand out a similar leaflet with an invitation from myself and our charge nurse.

Slowly, the stories began to trickle in and I was able to respond from a clinician’s perspective! I vividly remember my first response and the intense worry that I would “get it wrong”. This was going to be in the public domain, so it had the potential to poorly represent NHS Borders if I didn’t do it “right”. Although CO stories are anonymous, from the information provided I recognised the patient who had had longer term IV therapy with us via our ambulatory care service. I wanted to acknowledge the relationship that we had established during his episode of care and personalise my response, but was advised internally that I should avoid doing this.

Patients and relatives leaving stories are not looking for a standardised organisational response

Now I have responded to many stories, I feel that the empathic and individualised response is in fact the best approach. I believe that patients and relatives leaving stories are not looking for a standardised organisational response, but the knowledge that they have reached the people that have looked after them and who can make changes if necessary. I am no longer daunted by the thought of responding – now I take pleasure being able to thank people for their kind words and plan changes if concerns were raised.

As the stories continued to arrive, I found that raising awareness through tweeting about the stories was a good way to raise the profile of both Care Opinion and also the excellent work within NHS Borders. I used every positive story to praise staff and forwarded the feedback to those working at the “coal face” and also to our executive team, so that they were aware of the outstanding job the people of the Borders thought they were doing!

Where the stories were less positive, I saw it as an opportunity to make a change so as to deliver a better experience next time! For example, we created a new information leaflet about our acute assessment unit (where waiting times can be several hours) and promoted Care Opinion within our discharge lounge.

In May 2016, with the full support of our executive team, we formally launched Care Opinion in NHS Borders. This involved an open invitation to all staff members to come along and hear more about Care Opinion and how it works, along with communication to patients and relatives through social media and local press. At that time we had 3 responders. I am absolutely delighted to say that we now have 132 responders across multiple disciplines and specialties. It is not uncommon for a single review to have multiple people responding both from a clinical and management perspective.

As our story numbers increase, staff tell us about how their morale is lifted by reading about patients’ experiences and their gratitude for the care we are providing. There is also growing recognition of the power of the patient voice in shaping changes to service and the real value this has.

As a clinical director, I have found Care Opinion to be an incredibly valuable tool

Ultimately, as a senior clinician and clinical director, I have found Care Opinion to be an incredibly valuable tool in hearing about our services directly from those who use them. If I was offering advice to clinicians planning to use CO within their own organisation, I would suggest the following:

• Start small. Introduce CO within your own clinical area and then share the amazing stories you receive. (I would strongly suggest Twitter for this – be sure to tag your organisation and any interested exec team members). I also tweet about our negative reviews as I think it is important to show that we are an open organisation, listening to everyone and making changes.
• Actively seek feedback. Hand out leaflets inviting patients to tell you of their experience. Put up stories that you have already received so people can read them and understand the process.
• Involve clinicians of all disciplines. Your feedback will involve praise and occasionally criticism of all kinds of staff and it is great to have multiple clinical responders. Remember that the patient/relative wants to reach people involved in their care directly, unlike the complaints process which is a much more formal organisational response.
• You will meet objections, particularly from senior medics. There is a great fear of negative feedback in the public domain. Remind doubters that all stories are moderated by the Care Opinion team, and there is no naming and shaming. Remind them also of the value of negative experiences in helping to redesign services for the better. And remember that the majority of stories told are very positive rather than negative.
• Be personal in your responding. Although stories are anonymised, you may recognise a patient from the information that they provide. Humanity is incredibly important in your response and so it is okay to say sorry and to outline how you might wish to do things differently in future. Tell the story author about sharing their feedback with staff, and how this helps morale – because it really does.

So to conclude, I strongly recommend actively using Care Opinion to all heath care professionals interested in shaping the future according to our patients’ needs.