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Beginning - 'the land of ifs and buts’

Update from Poole Hospital Palliative Care Service

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picture of Saskie Dorman

This blog is by Jackie Le Fevre, values specialist at Magma Effect, and Saskie Dorman. It's the blog 2 of our blog series - you can read blog 1 here

We thought everyone would think this project was a good idea.

In truth, generally colleagues responded positively when the idea of actively seeking deeper and richer feedback was described. Staff across the partner organisations expressed initial interest in the project and then momentum frequently stalled. If the idea was good and the project was interesting, what could possibly get in the way? Welcome to the land of ifs and buts.

When we are presented with something novel – such as a new project to consider – our amygdala lights up. This small structure in the brain has a bias towards the negative. Studies suggest that about two thirds of amygdala neurons are geared towards noticing the down side. So perhaps we could have anticipated some of these questions and been better prepared.

  • What if we get overwhelmed by feedback stories on Care Opinion?
  • What if every experience everyone writes about is a bad one?
  • What if the criticism is unfair or untrue and other people read it?
  • What if people suggest things that should be improved and we can’t improve them?
  • But we care for people towards the end of their lives. How can we know when to ask for feedback?
  • But we have so much to do. How can we find time to fit this in too?
  • But we don’t want to sound like we are fishing for compliments, so how can we ask?

Clearly we had a job of work to do in finding answers to completely valid and understandable concerns.

What we did

We sensed it was important not to rush anyone. We decided to start small – inviting a small number of people to share their experiences.

Initially it felt a bit “clunky”. But people didn’t seem to mind being asked at all – in fact they seemed glad to help.

We were able to show we weren’t overwhelmed by volume and positive feedback was more frequent than negative feedback.

This was encouraging, but did it follow any kind of pattern? We asked Sarah Ashurst of Care Opinion what their experience was of the different kinds of stories shared.

“It’s fairly similar in all sorts of settings. Two thirds of stories or experiences shared on Care Opinion are consistently positive.”

One of the main reasons for developing this project in the beginning was to support all the partners in learning faster together for the benefit of patients and colleagues. So rather than leaving each team to come up with their own material to encourage staff engagement in the conversation, we developed shared resources: posters, postcards and widget codes to help individuals find the right web page to tell their story.  

At the same time we developed a ‘Framing the Ask’ handout for staff and volunteers. This responded directly to the anxieties expressed about the challenge of even starting a conversation. This took the form of highlighting something a patient or carer or family member might say such as ‘everyone has been so lovely….’ or ‘I never thought it would be like this….’ And then provided an example response which acknowledged and appreciated what the person had said and then suggested that they might like to share their insight to benefit others.

Recently Sarah pointed us at a useful article in the Journal of Patient Education and Counseling (2018). Researchers Michelle van Velthoven, Helen Atherton and John Powell explored individual motivations for providing online feedback about health services. They found that people have three main reasons:

  • to share information to benefit other patients
  • to praise a service
  • to stimulate improvements in services

Interestingly those motivations mirror the prompts we had intuitively arrived at in our ‘Framing the Ask’ resource.

It had taken a while (many things did under the weight of the pandemic) but we were ready to scale up our efforts and see where they took us. 

Thanks for reading. 

Next Time: what we learned in the early days

  • How did people respond when we asked them to share their experiences? Did we find that people are happy to help when asked?
  • If fear was a limiting factor in colleagues and volunteers seeking feedback, could it be overcome?
  • Can the stories shared by patients, families and carers point us at things to improve without breaking the budget or overloading already fully stretched services?


Michelle H. van Velthoven, Helen Atherton, John Powell (2018). A cross sectional survey of the UK public to understand use of online ratings and reviews of health services. Patient Education and Counseling, Volume 101, Issue 9, Pages 1690-6. Available at:

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