Using patient experience feedback to improve health services

Who?

Patients and NHS staff

What?

Working out how we can collect and use patient feedback to improve NHS services

Aims

  • To understand how to use Patient Reported outcome Measures (PROMS) in to improve clinical practice
  • To understand how we can use online patient feedback in a way which can improve health services

Why this is important

Health services are striving to find ways of improving patient outcomes – whether and how much a condition and its associated effects on people’s lives improves – and the quality of care they provide.

One way for the NHS to achieve this is to listen to patients.

However, simply collecting patient feedback is not enough. NHS organisations will need the tools to properly collect and understand patient feedback to improve health services.

Patient feedback can come in many forms, both formal and informal.

An example of formal feedback would be the use of Patient Reported Outcome Measures (PROMs). PROMS are questionnaires which ask patients about their health and quality of life before and after a treatment. For example, before and after a hip operation a patient may be asked to choose one of three statements which best reflects their health on that day, such as “I have no problems in walking about”, “I have some problems in walking about”, and “I am confined to bed”.

Informal feedback might be someone leaving comments about their healthcare experiences on a website. This could be anything from websites dedicated to such feedback, such as patientopinions.org, or blogs, social media, and online forums.

How much this feedback, whether formal or informal, actually results in improved health services is, at the moment, unclear.

For example, there is currently little evidence that clinical staff are using PROMS to improve services. This is despite patient experience being described as ‘the final arbiter in everything the NHS does’ by the current NHS Operating Framework for England.

Research into online feedback has mainly focused on numerical ratings, such as scoring care as a mark out of five, and using this to act on and track improvements. While numerical ratings are easy to analyse and interpret, free text comments are a potential trove of the things patients find most important, and therefore opportunities for improvement.

If we can understand the strengths, limitations and biases of these different forms of patient feedback, we can find ways to better harness it to influence and drive real improvements – the improvements patients care about – in NHS services.

Methods

This programme of work will have multiple components. It will focus on two types of patient feedback: PROMs and online feedback.

PROMS

Our PROMs research will mainly focus on working with local partner organisations who are, or intend to, make use of patient experience data for quality improvement.

Creating and developing partnerships with these organisations will be a key part of this project. This will allow researchers and clinicians to learn together, within their different roles, what works in using PROMs to improve services.

This will include:

  • supporting partners in the best methods for developing, collecting and analysing PROMs
  • workshops and seminars to share experience and aid learning
  • semi-structured interviews and engagement with patients about the value of PROMs
  • comparative case studies of collaborators’ experiences with PROMs

Interviews and case studies will be examined to draw out the main themes around using PROMs to improve services.

Online Patient Feedback

We will work closely with two local NHS partners. We will use these partners as case studies for examining what knowledge can be harnessed from online feedback.

We will also partner and work with a range of websites which host patients’ reviews and ratings. This will include PatientOpinion, IWantGreatCare, and NHS Choices. We will also examine more general discussion sites and social media where comments about health services are also made.

We will test out different approaches to identifying, harvesting, analysing, interpreting, and presenting this online feedback.

This will include in-depth qualitative analysis, such as assigning feedback identifiers based on their content or main themes.

We will also explore using computers to analyse feedback. This will include:

  • text mining – using a computer to extract and link together information from written feedback to reveal new facts, connections or ideas to explore; and
  • sentiment analysis – where a learning computer program is taught how to identify and extract subjective information automatically from written feedback. This allows large amounts of text to be broadly categorised as good or bad, for example.

Once we’ve analysed this data, we will work with our NHS and other partners to interpret and understand what usable information can be harnessed from online feedback.

How this could benefit patients

This project will result in clear guidance about the use of PROMs and online patient feedback, giving NHS organisations the right tools to make a real difference to patient care.

Importantly, we will develop our findings into a free toolkit which can be used by NHS organisations.

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