Why all doctors should use Patient Opinion.

Update from Surrey and Sussex Healthcare NHS Trust

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picture of Ben Mearns

As the Clinical Lead for Acute & Elderly Medicine it is my responsibility to ensure that the Departments that I lead are safe, effective, caring, responsive to need and well-led. This is how the CQC will judge us and rightly so. But how do I prove to myself, my teams, the wider NHS and the public that we are doing the right things? Or if at times we are not, how can I show that we have learned?

One of the most important ways that we can assure ourselves that we are all of those things is by listening, really listening, to our patients, their loved ones and carers. It follows that we can give others assurance by doing our listening in public.

It is a long-held tradition in medicine that research is conducted in public. This allows peers to review the research and to agree, disagree or make suggestions. It also allows the world to see that there is nothing to hide.

I see patient feedback in the same way.

Patient Opinion takes the control of the publication of information away from those of us that run the service. It made me uncomfortable at first, because when we didn't do our best it was plain for all to see. In fact I told our Chief Executive that I was concerned about morale when he decided to put patient opinion's feed on our intranet homepage. Every day when you opened your computer the feedback was staring right at you. This didn't feel great when we were struggling to run a busy emergency service with too few beds a few years back. However it suddenly occurred to me that with a very sick patient I wouldn't want to ignore an abnormal blood test result so why would I want to do the same with feedback when the hospital was under stress? I changed my view from the feedback being criticism to seeing it as an indicator. Sure there is a personal reason to make sure each patient gets a response to a concern, but the bigger picture is even more important. The pattern is key.

As a Physician I like gathering information and making a diagnosis. I love watching patients get better on the right treatment. But you can only give the right treatment once you have the correct diagnosis.

I see hospitals like I see patients now. If the results look abnormal, you need to diagnose the problem and give the right treatment. And if the treatment doesn't work, guess what, the results don't get better. Patient Opinion is like one a the hospital's physiological observations - like a blood pressure chart. And when we made our hospital's diagnosis and put in the right treatment the results stabilized and got better and better. That was the best feeling in the world.

Is it a problem that Patient Opinion is anonymous? Absolutely not. If it was not "blinded" then patients may not be honest. Some patient fear telling the truth as there may be consequences. I hope that our work proves to our patients that this will never be the case, however anonymity definitely allows everything that needs to be said to be said. The site then allows us to respond and offer a more personalized response if the patient would like to give us their details via email, etc. and this works well for me.

So do I feel comfortable being so transparent? Putting myself out there on Patient Opinion, Twitter, etc. Well so far I do, because following the Francis report I believe that this is what is expected of me now. I feel that the NHS and Government would defend doctors like me if I do slip up whilst trying to do the right thing for the hospital, the patients and the NHS. I hope that this is true, but everything I hear tells me that it will be. I also hope that those who follow us are reassured by what they read.

I suppose the important thing is that I now feel confident that if there was a problem, or a patient had a concern, then I would know about it. It feels liberating to know that everything bad that can be said, almost certainly has been. And its amazing that the majority of patients have taken the time to write lovely comments as well. Both of these things give my team and I a huge boost. I'd always rather know than not know. If I know, I can fix it. And as our Chief Executive presumably had planned, our morale improved as the feedback got better. He knew that doctors love nothing more than fixing things.

I hope that my colleagues will feel the urge to dive in and see for themselves, because Patient Opinion has made me much more confident about the care that we deliver and that makes me happier.

So when the CQC come to visit and ask me if my departments are safe, effective, caring and responsive to need I will be able to use Patient Opinion as evidence to assure them that the answer is most certainly yes. I will leave "well-led" to the team to decide (fingers crossed).

Dr Ben Mearns

Clinical Lead for Acute & Elderly Medicine

Response from Richardkerley - doesn't use nicknames on

Your 3rd para strikes has a  remarkable resonance for me in respect of academic research [ peer reviewed; published ; open to criticism etc ] . Contrast that with Teaching & Learning [ usually unobserved ; one to many in semi-private  ; often not commented upon] There's a paper there somewhere... 

Response from Ben Mearns, Chief of Medicine, Surrey and Sussex Healthcare NHS Trust on

Dear Richardkerley

Thanks for your comments. I know its not quite the same, but I think that the principle of conducting the conversation in public is similarly useful for feedback as well as research.

I used to (and still do) write complaint responses back to patients and their relatives and no one but them could see them. Their original complaint was never seen by the wider public. It just seems that there are loads of opportunities for learning how to improve in that conversation that are never used. Its all been rather defensive and hidden. What we want is to be collaborative and open.

Whilst some patients will still want these matters held confidentially and indeed organisations need to be in some way protected from unwarranted attack I think more and more will be willing to add to the common debate and that should drive improvements across the NHS. Patient Opinion seems to get that balance right.

It also allows peers to check other organisation's feedback which can be useful to both parties. Wouldn't it be nice if one NHS organisation offered to help the other because they'd already dealt with a similar issue? I think we're a way away from such sharing though!

Its great reassurance to me that other healthcare professionals are checking up on me, because they should be telling us if we're getting it wrong. Therefore hopefully our governance is good. It gives me a great deal of reassurance which is the exact opposite of my initial anxieties about "washing our dirty laundry in public". In fact we now have a lot of very clean laundry so the odd stain is to be expected.

I appear to have become a philosopher!

Response from Michael Greco, Chief executive, Patient Opinion Australia on

I found this post of exceptional value.  Thank you Ben.  Everyone's experience of Patient Opinion is different.  You seem to have captured something that is special, and have been able to put words to that experience.  I will share this with our Australian followers.

Response from Ian Mackenzie, Director of Information and Facilities, Surrey and Sussex Healthcare NHS Trust on

Dear Ben,

As usual you put things more eloquently that I would, but I so strongly agree with what you're saying.  I too felt that publicly displaying our Patient Opinion reviews had the potential to lower morale but now nearly two years later I think it has been a crucial part of changing the organisation we both work for.   

Why we choose - or perhaps are chosen - to embrace this kind of public discussion about our patients' care will undoubtedly be different for each of us but for me it came at a moment when I suddenly realised that we all of us have the power and ability to make a difference; but we have to seize that moment.  

My moment was being a carer myself and seeing that small things made a huge difference and yet somehow so often got overlooked.  I decided then that I wanted to try and make those changes - perhaps I'm lucky in that my role gives me a certain power to do things - so that others could get the benefit of them.   I try and do this as often as possible but I know that I have a huge way to go.    

I don't talk directly to patients anything like as much as you do (or as much as i should) but only today - following a twitter introduction - i was talking to an inpatient  and he spoke so positively of his care and experience and those small things that I know that that it is absolutely right to do as we have done and must continue to do in the future.

Best wishes

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