Impact #2 - The liberation of feedback

Update from Care Opinion Scotland

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In the second of our Impact blogs, Director of the Scottish Recovery Network, Simon Bradstreet, (@SimonSRN) reflects on the role of online feedback.


As a regular reader and distributor of Patient Opinion feedback on Scottish mental health services I’ve always liked the easy access the site provides for people to have their views heard. When I was invited to contribute this posting the brief was to comment on what difference I saw it making. Two things struck me as worthy of mention – the importance of exposure and the power of disruptive innovations. 

I’ve read feedback on mental health which has ranged from fulsome praise to damning indictment. It seems to me positive feedback often focuses on very human elements of service provision – the kind word, the warm welcome, the tailored response. While positive mental health feedback appears to be in the minority its role is vital. It offers tips for what is working that can be shared more widely and boosts morale in hard pressed teams and services. Feedback systems in the NHS had been strongly focused on managing complaints, and I’d agree with the sentiment that “If all you have is a complaints system, perhaps everything looks like a complaint?”.

My reading of the less positive mental health feedback is that it often relates to challenges in accessing help in the first place. This might feel like familiar territory to those of us involved in the sector but the wider exposure of direct testimony from people clearly experiencing distress who have been denied help for any number of reasons is important.

For me Patient Opinion exposes some of the real challenges we face in mental health and offers a starting point for discussions about how we might radically alter our approach. It also reminds me that the conversation about how we re-shape our response to emotional distress, for example to encourage prevention and early intervention, is a discussion that must involve all sectors of society given we are all deeply affected by mental health.


Patient Opinion is also, I would argue, a great example of disruptive innovation. A highly appropriate place to research the topic is Wikipedia because it is in its own right a fantastic example of disruptive innovation. It's a concept developed out of business where new technologies or innovations (like Wikipedia) radically shift existing markets (like encyclopaedia manufacture and publishing). I believe the same principles apply in public service reform.

Through Patient Opinion and similar tools, the management and exposure of feedback has been liberated from the confines of carefully controlled complaints systems. This brings with it a shift in power from systems to individuals, which can feel uncomfortable and threatening. However, a characteristic of disruptive innovations is their permanence so in my view how systems and services adapt to these new paradigms is a good indicator of their ability adapt to future challenges in public service provision.

Response from family carer on

I believe that the disruptive innovators in health board settings are the people who speak out from the grassroots with a critical voice which then creates space for others to give honest feedback. 

They may be whistleblowers, staff who have spoken out about bad practice and it has cost them their job.  Or patients and carers who have been at the receiving end of inhumane treatment and had to take their case to the Ombudsman as a last resort.

I think that Patient Opinion is a useful tool and way for people to give feedback, and for health boards and other agencies to listen.  A mediator in a sense.  A neutral space.  However I do not agree that it is disrupting the fabric of the system or creating a new market.  Rather Patient Opinion is helping health boards to do their job more effectively and is therefore like a bridge.

Response from James Munro, Chief executive, Care Opinion on

@SimonSRN, many thanks for your stimulating blog post. I do agree with your emphasis on the importance of positive as well as negative feedback. Our experience is that the positive feedback is so important in building trust with staff that Patient Opinion is not simply a new way to criticise people.

family carer, thanks for your response and for questioning the label of “disruptive innovation” as applied to Patient Opinion.

It seems to me that the notion of disruptive innovation is that it applies to new market entrants which offer far cheaper ways of doingexisting things. In that sense, I do think that Patient Opinion is potentially disruptive to standard processes for feedback and complaints.

In practice, though, I don’t think we are (yet) particularly disruptive, because we have yet to scale sufficiently. And, of course, we may be disrupted in turn by something even cheaper or more effective. For some people, that would be Twitter. Though if I were a patient wishing to give feedback, Twitter wouldn’t be my first choice.

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