How can online feedback be combined with existing improvement methods?

Question from Care Opinion

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Earlier this month, iHub (part of Healthcare Improvement Scotland) published an evaluation of two approaches to improvement based on patient/carer feedback.

The report was authored by Diane Graham, Claire Curtis and Claire Scrim.

The findings of the evaluation are fascinating from my perspective at Care Opinion. In this post I will briefly describe the improvement approaches and the key learning (apologies in advance if I misrepresent these). After that I'll discuss how this might connect with our work at Care Opinion.

The improvement approaches

The evaluation was of two different approaches to improvement based on patient/carer feedback, which were tested in 32 acute or community care teams in Scotland. The two approaches were actually very similar, and looked a bit like this:

The improvement approach

In the "real-time" model, the feedback comes from conversations with people who are currently receiving care. In the other, "right-time" model, the feedback comes from phone conversations with people two to three weeks after the episode of care has finished.

Both approaches relied on some important common elements:

  • care experience was gathered as narratives, not surveys
  • regular facilitated team meetings allowed reflection on the feedback, and agreement on improvement opportunities which could be addressed
  • initially, care teams were supported by experienced facilitators familiar with both narrative data and improvement methods.

Did it work?

Yes, it seemed to work pretty well. Staff liked the approach, and it was interesting to see that so many staff comments were just like the ones we hear from Care Opinion subscribers:

"We're realising that patient expectations are not the same as our assumptions."

"Previously, although services were collecting feedback there was little evidence of the feedback being used to inform improvements."

"We didn't understand how powerful and compelling it would be... in the terms of the emotion, it generates an energy to take action."

"Much more detailed and useful than the universal feedback forms."

In both approaches, the teams found improvement opportunities in about one in five of the structured conversations. About half of these resulted in some implemented improvement. The model where the feedback came from people still receiving care seemed to work better in producing tested and implemented improvements.

Reflections from a Care Opinion perspective

My first reflection is that this approach to improvement seemed simple, straightforward, and rewarding for staff and patients alike. I was impressed that any conversations at all resulted in practical service improvements, given what we know about how hard it is for staff to use patient feedback for change.

Second, I wondered whether stories on Care Opinion could offer an alternative source of patient-derived improvement opportunities. After all, many stories do identify things which could have been better, and some teams are already very good at logging changes as a result.

Of course, online feedback will have pros and cons compared with in-person conversations. It may be shorter, less rich, and less able to provide improvement opportunities. But on the other hand, it may be less costly, more scalable across many teams, and preferred by some patients.

And because online feedback is public, improvement opportunities could also be identified by people beyond the team. Perhaps we could even crowdsource identification of both areas for improvement, and potential solutions?

Third, using online feedback as a source of experience also offers the opportunity to post the team's ideas, plans, tests and conclusions online in response to the story. This would allow the person who shared their experience (plus everyone else) to see the work of improvement happening "in the open". The response system on Care Opinion already lends itself to this, and could be tweaked if needed.

(As an aside, the evaluation report didn't comment on whether those people who shared their experiences found out what happened as a result.)

Finally, the evaluation comments on the possibility that an important element in the success of the real-time approach was the "sense of urgency" that real-time feedback generated for the care team. It may well be that by taking their feedback from Care Opinion, and reporting back to the patient (and all of us) online as the improvement work progresses, there is an additional sense of both urgency and accountability.

These are just my own first thoughts after reading the report. These ideas may be unrealistic or even undesirable. But I think they are worth discussing, and perhaps even worth testing.

Do let me know what you think, by posting a response below or commenting on Twitter with a link to this blog.

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