Across the UK, most stories received by Care Opinion are posted by story authors themselves. However, posting feedback may be difficult or impossible for some people who want to share a story, or in some service settings.
For example, in some settings, such as high secure mental healthcare, or prison healthcare, internet access may be blocked. Typically in these settings feedback may be sent to Care Opinion by post. In some services many people may lack email or digital skills, or have cognitive, physical or sensory disabilities, which make it difficult for them to post their feedback online themselves. In such services, staff will often help people to get their feedback online by posting it on their behalf.
Care Opinion encourages staff doing this to flag the story as submitted “on behalf of a patient”, so that we are transparent about how stories come to be online.
In the decade 2011-20, 7% of stories were submitted by staff on behalf of patients or carers. This proportion has risen markedly since then: in 2022 19% were submitted by staff, and in 2023 to date, 24%.
What are the disadvantages of staff submitting stories on behalf of authors?
Although, as discussed, submitting stories on behalf of authors can help overcome obstacles to feedback for some people, or in some settings, there are also significant disadvantages for authors, staff and services.
Disadvantages for authors
Feedback works best when the feedback author has had a chance to reflect on their care, has identified aspects of care that mattered to them (whether positive or negative), feels free to share that experience authentically, and then sees that their feedback has been heard, acknowledged and perhaps led to learning or change.
When staff collect stories in person, or help someone post a story on Care Opinion, many of these prerequisites for meaningful, reflective and insightful feedback may be absent:
- If stories are gathered from people still undergoing care, it may be too soon to have reflected on the overall experience
- If the author is in the care setting, they may not feel safe to give critical feedback
- If the author is interviewed by staff, their storytelling may be shaped by the questions asked, rather than by what matters to the author
- If the author is interviewed by staff, their feedback may be limited by the need to maintain a good relationship or please the staff member
- If the staff email is used when adding the story, the author is unlikely to see any response to their feedback, and cannot themselves respond further
Thus, feedback collected by staff is likely to be less nuanced, more uniform, and perhaps more positive than feedback entered by authors after they leave the care setting.
In addition, because the author has not interacted directly with Care Opinion:
- They miss an opportunity to gain the knowledge, skills and confidence which might enable them to use Care Opinion in future
- They miss an opportunity to read and reflect on what others have said about the services they are using
- They do not see and understand how their voice is joining with others in “caring for care”
- They will be unable to participate in other ways, such as reading blogs, marking responses as helpful, or joining the participation community and supporting research or improvement projects
Disadvantages for staff
The disadvantages for authors are likely, in turn, to result in loss of meaning and value for the staff receiving and responding to feedback:
- Stories may feel more uniform and even repetitive
- Stories are less likely to raise new or surprising issues
- Stories may feel less personal, authentic and heartfelt, and will lack any information about the impact of the care after the author has gone home
- Staff may feel less connected to story authors
- Responders may feel that their response matters less, if it will not reach the author
- There is no opportunity to seek further information from the author, or any confirmation that a response has resolved an issue or restored a relationship
These disadvantages are both informational and relational. If a high proportion of feedback is submitted by staff on behalf of patients, there is likely to be less new information, and less impact on culture and relationships.
Disadvantages for services
There may also be wider disadvantages for services, teams or organisations.
If a high proportion of stories are posted by staff, then:
- Public users of the site may wonder whether the feedback is still independent of the organisation, or is a true reflection of people’s experiences
- The service or organisation may be viewed as less transparent, with the risk of reputational harm
- As the Care Opinion participation community develops, there will be few authors who can be contacted to support improvement or other projects
- There will have been a missed opportunity to grow a community of supporters who have shared feedback, been heard, and become repeat users or advocates for both the healthcare provider and for Care Opinion
Care Opinion guidance on stories posted by staff on behalf of patients or carers
There are clearly times when staff help can enable someone to share feedback which would they would not otherwise have been able to do. Care Opinion is fully supportive of this.
But in general, we believe that in most services this route to giving feedback should be the exception, not the norm, because of all the disadvantages set out above.
We suggest that instead, in most services and for most people:
- Services and staff should use a range of methods to raise awareness of Care Opinion and invite feedback (for example, prompts may be environmental, interpersonal, or administrative)
- People should be invited to give their feedback at a time and place that best suits them, typically when no longer in the care setting
- People who might need support should be encouraged to look first to family, friends or others, rather than to staff, to help them
- People who need help to use technology, get an email address or grow their digital confidence should be signposted to relevant local services which can help
We recognise that this approach may, at least for a while, result in fewer stories being told. Despite that, it is likely that the overall value and impact of the stories which are shared will be greater for authors, staff and organisations.
What proportion of stories shared by staff would we expect to see?
In keeping with experience over the past decade, we would expect less than 10% of stories told about an organisation to have been submitted by staff.
There is likely to be variation within a large organisation: in some specific services the proportion may be far higher than this, but conversely in most parts of the organisation we would expect the proportion to be far lower (i.e. less than 5%).