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There is already a better way

Update from Quality Improvement

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Ian ReevesWelcome to our new Quality Improvement blog. We're proud to be launching our blog with this guest post from Dr Ian Reeves, a consultant physician in Glasgow, who sets the scene with a clinician's perspective on Care Opinion.

I was discussing a written complaint process with a colleague. The hospital had provided a lengthy written response to concerns of a family about inpatient care over several days. The investigation of this complaint had clearly taken a lot of time and absorbed further ward staff energy.

When they read the letter, the family were disappointed. They felt they had received a wordy but rather corporate and standardised response. Their real aim – to have their voice heard at the ward level – seemed to them to have failed.

As a result, they referred their complaint to the ombudsman where the care and complaint process was reviewed.

In reviewing the complaint there was a lot of empathy for the family’s experience. They had made significant efforts to write in detail, and with emotion, to the hospital, but this level of involvement and care didn’t seem matched by the rather bland response.

Although some of the ward’s failings in care were real, the hospital seemed to view them as relatively minor, as ‘it didn’t make a difference in the end’. The process of responding to the complaint had also been poor. The hospital had taken a long time to produce a report, which included only a partial apology.

The family wanted to be heard in a more meaningful way

What was clear to me, in reviewing this, was that the family wanted to be heard in a more meaningful way, rather than feeling that they were the passive recipients of an administrative process.

My colleague, the very wise nurse Dorothy Armstrong highlighted Patient Opinion (now Care Opinion) to me. Gina Alexander had been introducing this in Scotland and Dorothy told me that she had been impressed with their approach, which seemed personal, rather than systematic. I hadn’t heard of it, which is still a common response from clinicians when I eulogise about it today.

After hearing more, I used the Care Opinion process in clinics and in wards, and was impressed. It was quick and personal: a world away from the clunky industrial-era complaint process.

In the organisation I work for pockets of other early adopters also used the process.

The most powerful example of where it was used in a systematic way was one of the wards. The ward staff promoted the use of Care Opinion rather than thank you cards or complaints. They printed the stories on yellow paper and displayed prominently them on the wall. This led to visitors and patients reading them, and a further increase in use. This has had the benefit of near instant feedback, with a public record of what we have said we will do.

The feedback wall on ward 8A

The balance of negative and positive feedback is a very important aspect of Care Opinion. It is not all negative, and the boost in staff morale from a positive story lasts a lot longer than a box of chocolates. Patients and their families find it a very good way to highlight good care.

It’s not perfect. Beyond the small pools of progress, such as ward 8A where Care Opinion is evolving well, large organisations have often struggled with the process.

One of my colleagues had a positive story published, followed by the usual corporate response promising to let my colleague and the secretary know that their care had been appreciated in this way. I saw my colleague a couple of weeks later and asked if he had seen this positive story.

He hadn’t. To this day, despite the online response to the story, it would still would not have reached him had I not shared it. The story author wanted to thank my colleague and his secretary personally, and took the time to post on Care Opinion – but the organisational response was not as careful and personal as the gratitude being offered by the patient.

An increasingly complex NHS needs new ways to connect people and their services

Like healthcare in general, Care Opinion works very well when there is a rapid and personal approach. It works less well when it becomes part of 'old system' bureaucracy which, even if it is online, isn’t at all modern. Used like that, it becomes just another face of the corporate machine with a web link instead of paper.

Care Opinion has the unique ability to connect people and services in an immediate and personal way. An increasingly complex NHS, with fragmented and impersonal care becoming the new norm, needs new ways to connect people and their services. Care Opinion does that like nothing else around.

So, there is already a better way: Care Opinion. Let’s use it.

Response from Ian Reeves, Consultant Physician, NHS Greater Glasgow & Clyde on

Hat Tip (belatedly and with apologies) to @CC270681 - Collette Campbell who is the inspiration behind the ward 8A QEUH use of Care Opinion

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