Real Time Patient Feedback

1
Real Time Patient Feedback Best Practice in the
West Midlands

• Mary Parkes NHS West Midlands
• Hilary Brown, Health Services Management Centre

2
Why did NHS West Midlands commission this Study

• Patient experience feedback centre stage
• Use of patient experience feedback growing
• Concern that much work is ad hoc
• Not sure how widely used - methods
• Find out how systematic use was is it
  influencing commissioning
• PCTs Trusts need to develop competencies
• No clear guidance on what is best practice
• Clarify place of real time

3
Research methodology

• Initial data gathering via internet overview of
  users, methodologies, suppliers etc. to provide
  additional examples and case studies
• Health Care Commission, Patient Information
  Forum, DH, IDeA, LGA, National Social Marketing
  Centre, International Journal of Market Research
• Two academic literature searches health
  management database and combined business and law
  database
• Questionnaires
• Semi-structured interviews

4
Findings of Research

• Users value being asked little feedback action
• Culture - patient engagement led from top
• No one method suits all need to choose
• Use of feedback increasing but not systematic
• Lack of comparable data for benchmarking
• Great emphasis on data analysis capacity?
• Little evidence feedback influencing services
• Real time useful for hot spots follow up?
• Once collected, not shared, little feedback

5
Engaging people and soliciting feedback the
practitioners perspective

• Range of methods required to maximise response
  rates, increase representation and avoid bias
• Patient/service user enthusiasm for feedback
  related to power to change or improve things for
  others
• Exercise only as good as resulting action
• Survey design should be informed by
  patient/service user what are the right
  evaluation questions?

6
Research findings methodologies

• Face-to-face - most inclusive method, takes
  longer and produces fewer responses, requires an
  investment in training and administration,
  qualitative and therefore rich source of data,
  interviewer can have moderating effect on
  responses
• Paper-based - cheap, convenient, user-friendly,
  obtains large quantities of quantitative data,
  preferred by certain demographics,
  self-administered higher reporting of
  undesirable behaviour, comment or feedback cards
  can result in mostly extreme responses
• Hand-held devices potential issues re sample
  size and representativeness, generally
  user-friendly (devices can be adapted), great
  variety in number of questions (quantitative with
  some provision for free text), produce high
  number of responses in short timescales

7
Research findings methodologies

• Kiosks anonymous, self-selected sample,
  generally user-friendly, quantitative data but
  poor use - not visible enough, purpose not
  explained and no assistance or encouragement,
  time pressures etc, can be vulnerable to misuse
• Bedside terminals self-selected, quantitative
  data, incentives for completion, use of mobile
  phones affect future use of bedside units
• Telephone interviewing random consumer
  research, opportunistic follow-up, prearranged
  different response rates and either intrusive or
  convenient, moderating results with interviewer,
  CATI quick, cost-effective, less detailed
  responses, lack of universal coverage as land
  lines declining

8
Research findings methodologies

• Online questionnaires - internet coverage not
  universal, self-administered results in higher
  reporting of sensitive information, more complex
  structures, respondent fatigue more evident,
  ability to gather a lot of data in short time
• Other online methods - use of organisations own
  web-site online communities large volumes of
  qualitative data, quick and convenient, ongoing
  feedback over longer periods of time but require
  significant amount of management and maintenance
  social media health-related chatter

9
Benefits of using real-time the practitioner
perspective

• Ease of use
• Staff attitudes real data, increased
  ownership, motivation
• Freshness of data - cause and effect easier to
  determine
• Perception of greater responsiveness by service
  users
• More likely to capture detail as not reliant on
  recall
• Prevent issues becoming problems and improve
  experience for others

10
Implications of using real-time the
practitioner perspective

• For what purpose is it being used?
• Unsystematic management of information
• Lack of expertise to interpret and analyse data
• Value of quantitative versus qualitative feedback
• How to turn feedback into actionable data
• Whose responsibility? Who is accountable?

11
Implications of using real-time the
practitioner perspective

• Query ease of use for all groups
• Potential positivity of response bias
• Reflection is an important element of giving
  feedback for experience rather than fact
• Not reaching people who are not using services
• Not closing the feedback loop for staff,
  patients and service users

12
Implementation the practitioner perspective

• Requires strategic and systematic approach
• Creating a structured process for quality
  improvement
• Building a system of leadership for improvement
• Developing a person centred approach
• Feedback to, and involvement of, staff
• Working with human responses to change
• Real time or right time
• Prioritising and decision making
• Managing expectations

13
Technology versus the human touch

• Real-time patient feedback through technological
  solutions has limitations, not least because it
  is largely limited to gathering responses to
  what questions
• There is a danger that technology will become a
  proxy for human contact
• Technology has an important part to play, but its
  introduction needs to be thought through
  carefully, to ensure that those providing direct
  care for patients, dont just regard themselves
  as transactional suppliers.

14
What is NHS West Midlands going to do with
results of research

• Develop and publish How To Guide
• Run 2 workshops to disseminate research
• Begin dialogue with PCTs re what would help
• Commission development programme - WCC
• Agree how PCTs can be more systematic
• Define small no of areas to benchmark
• Model data capture and sharing
• Review practice
• Contribute to/influence national policy