Jonathon Carr- Brown, Managing Director

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Jonathon Carr-Brown, Managing Director

Patient Insight and Service Improvement

Version 1.0

1st October 2013

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Purpose

How does NHS Choices collect patient insight?How does this inform service improvement?How does this inform patients and the public?

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Background

• The NHS Choices website currently gives the opportunity for NHS customers to give feedback on their service experiences through ratings and comments

• Current rate of posts is 7,000/month which has doubled since the start of the year

• On-line feedback appears broadly in-line with other service sectors that encourage customer comments and is similarly skewed towards younger, female, higher SEGs.

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Almost half (45%) are now aware of patient commenting

NO = 55%

YES = 45%

AWARENESS

Base: Total sample: 928

USED (Before today)

Once

2-3

4-5

5+

Never used it

= 24%

= 25%

= 5%

= 8%

= 38%

Were you aware of the patient feedback feature on NHS Choices before today?

How many times have you used the

patient feedback feature before?

Base: Total sample: 419

+19%

-19%

+7%

+4%

+9%Total2013: 62%2011: 43%

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Comments IncreasingN

umbe

r of c

omm

ents

pos

ted

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Big Unreadable Table

Comments Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13

Hospital 693 770 983 908 965 1090 916 937 925 952 888 721 1435

GP 1742 1747 2287 2096 2223 2923 1967 1683 1636 1928 1901 1395 2764

Dentist 506 589 808 731 818 764 715 742 716 780 801 561 1142

Pharmacy 35 30 57 50 57 75 62 74 63 75 49 78 153

Optician 8 12 23 18 9 12 17 13 9 14 20 14 29

Total Comments 2984 3148 4158 3803 4072 4864 3677 3449 3349 3749 3659 2769 5523

Visits 14503400 13831266 14616431 14301680 15888962 15605509 16028188 15967922 16394216 19751209 19797722 19292779 27311916

% of Site Visits 0.0206% 0.0228% 0.0284% 0.0266% 0.0256% 0.0312% 0.0229% 0.0216% 0.0204% 0.0190% 0.0185% 0.0144% 0.0202%

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Recent Research Findings

‘Feedback’ is defined by the general public by organisations like Amazon and Ebay - They do not understand the benefit of providing feedback within the NHS

There is no clear motivation for NHS Users to provide feedback on services - They do not believe patient feedback can influence change or help patient choice within the NHS

A Telephone Feedback Line will bring in some additional commenters - But without communicating how and why consumers should use it, it is unlikely to reach a wider audience

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What’s the Issue 

• NHS customers, accept, in principle, that a similar model for logging and posting customer feedback and reviews could be established for NHS services. In practice, this is inhibited by fundamental perceived differences between an NHS provider/patient relationship and a commercial supplier/purchaser relationship. Patient/NHS partnerships have stronger emotional and personal elements that do not fit neatly into the familiar feedback model.

• There is a need to educate NHS users of the end benefits of sharing and using patient comments to encourage participation. Expectation of achieving service improvements via patient feedback is currently low.

• There is currently low perception of patient choice within the NHS that will drive customers to search or post feedback. There is a strong belief that choice of GP and hospital is beyond their control therefore there is no recognised requirement to search for reviews and recommendations .

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Feedback = Commercial Websites

Used to check out goods before purchase:More reading than posting feedback

Providing feedback fundamental to buyer and seller ratings. Incentive to feedback

Useful research tool. Exceptional experience or wish to ‘balance’ negative comments triggers posts

• Feedback/reviews part of a website culture

• High awareness even among ‘non-commenters’

Definition and credibility of ‘feedback’ varies according to the organisation that requests it. Customers are more likely to engage where feedback is considered to be intrinsic to the customer experience and benefits, either personal or for the wider community, are recognised

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Engagement in a customer feedback loop depends on a persuasive reason to participate

What will be achieved?

Who will benefit?

Change in service

Change in behaviour

Self

All users/customers

Unlike complaints, no hard evidence of change or benefit is required by consumers to drive engagement, but motivation to engage must be credible as well as persuasive

Organisation

Compensation/reward

Altruism - helping others

Develops customer/supplier relationship

Key Drivers- Belief that feedback will have impact is important

Help shape future experiences

Encourage/discourage use

That’s what you hope isn’t it? If you’re giving

feedback there’s going to be a reaction: something’s

going to happen

(G4: non-commenters 40+ y/o)

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NHS customers have some difficulty in understanding drivers for feedback in the context of NHS services

What will be achieved?

Who will benefit?

Change in service

Change in behaviour

Self

All users/customers

Low belief in being able to influence change within the NHS is a major barrier to engaging in feedback with NHS services

Organisation

Best achieved via personal complaint/thank you not feedback

‘An ideal’ but doubt relevance of personal experience to wider NHS community

Doubt that NHS organisation will be able to effect change based on feedback

Key Drivers

Customers currently feel influencing change is beyond their control

Low awareness and credibility of choice within NHS services

Your relationship with the NHS isn’t a purchasing

relationship; it’s not about spending money, it’s about being treated

(G2: non-commenters ≤40 y/o)

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NHS customers’ deep affection for the NHS inhibits willingness to give negative feedback

• Far more leeway allowed for delays and inconvenience than in commercial customer/supplier relationships

• Concern that any criticism will impact on their future use of NHS services

• Communication with the NHS services is generally triggered by a serious ‘complaint’ requiring action and a satisfactory resolution

• Response to both is personal and directed

• Older NHS customers, in particular, do not yet understand the value of ‘constructive criticism’ in the context of shaping improvements in ‘their NHS’

NHS service users require educating of the benefits of ‘constructive criticism’. There is low acceptance that by sharing experiences they have the power to shape the future of ‘their NHS’

I couldn’t go and complain to my

doctor… there’d be this friction between

us

(G3:commenters 40+ y/o)

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Customers are happy to give positive feedback, but currently view this as a personal transaction between patient and service provider

• Low levels of expectation of NHS services (mainly hospital and GPs) means that when services go well it is ‘as it should be’

• ‘Customer delight’ when services far exceed expectations is generally rewarded in person to the individual provider

• Older NHS users, in particular, recognise the power of a ‘thank you’ but are the most likely to reward providers either verbally or with a small gift

• But recent potential closure of local services has motivated some (younger) customers to add their support on-line – a wish ‘to be counted’ among other supporters

The general public retains a strong affinity to ‘their NHS’ but positive interaction is usually directed at a personal, local level. Customers need to be persuaded that sharing their positive experiences more widely can benefit the broader community of NHS users

I just wanted to give a little support to them because obviously

they are facing difficulties at the

moment(G1: commenters ≤ 40 y/o)

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So… Feedback, as understood by the general public, does not currently fit naturally within the NHS space

•Not a commercial customer/supplier transaction

•Most experiences of NHS services are both personal and emotional

•Low expectation that feedback will result in changes to services

•Awareness and belief in ‘consumer choice’ within NHS services is low

NHS customers doubt credibility of ‘end benefits. Neither assisting others with consumer choices nor driving improvements are currently seen as achievable outcomes

• Who will be interested?

• What will it achieve?

It’s a bit different with the NHS because you can’t

pick a hospital

(G2: non-commenters ≤ 40 y/o)

For a service where I know the people

personally then I would rather say thank you

personally(G4: non-commenters 40+ y/o)