What does patient feedback reveal about the NHS? A mixed methods study of comments posted to the NHS Choices online service

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Abstract

Objective

To examine the key themes of positive and negative feedback in patients’ online feedback on NHS (National Health Service) services in England and to understand the specific issues within these themes and how they drive positive and negative evaluation.

Design

Computer-assisted quantitative and qualitative studies of 228 113 comments (28 971 142 words) of online feedback posted to the NHS Choices website. Comments containing the most frequent positive and negative evaluative words are qualitatively examined to determine the key drivers of positive and negative feedback.

Participants

Contributors posting comments about the NHS between March 2013 and September 2015.

Results

Overall, NHS services were evaluated positively approximately three times more often than negatively. The four key areas of focus were: treatment, communication, interpersonal skills and system/organisation. Treatment exhibited the highest proportion of positive evaluative comments (87%), followed by communication (77%), interpersonal skills (44%) and, finally, system/organisation (41%). Qualitative analysis revealed that reference to staff interpersonal skills featured prominently, even in comments relating to treatment and system/organisational issues. Positive feedback was elicited in cases of staff being caring, compassionate and knowing patients’’ names, while rudeness, apathy and not listening were frequent drivers of negative feedback.

Conclusions

Although technical competence constitutes an undoubtedly fundamental aspect of healthcare provision, staff members were much more likely to be evaluated both positively and negatively according to their interpersonal skills. Therefore, the findings reported in this study highlight the salience of such ‘soft’ skills to patients and emphasise the need for these to be focused upon and developed in staff training programmes, as well as ensuring that decisions around NHS funding do not result in demotivated and rushed staff. The findings also reveal a significant overlap between the four key themes in the ways that care is evaluated by patients.

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Most cited references 30

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Patient satisfaction: a review of issues and concepts.

J Sitzia, N. Wood (1997)

This review presents issues arising from an analysis of over 100 papers published in the field of patient satisfaction. The published output appearing in the medical and nursing literature which incorporated the term "patient satisfaction" rose to a peak of over 1000 papers annually in 1994, reflecting changes in service management especially in the U.K. and U.S.A. over the past decade. An introductory section discusses the setting and measurement of patient satisfaction within this wider context of changes in service delivery. Various models are examined that have attempted to define and interpret the idea of determining individual perceptions of the quality of health care delivered. Determinants of satisfaction are examined in relation to the literature on expectations, and demographic and psychosocial variables. These are distinguished from the multidimensional components of satisfaction as aspects of the delivery of care, identified by many authors. The review highlights the complexity and breadth of the literature in this field, the existence of which is often not acknowledged by researchers presenting the findings of studies.

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Systematic review of the literature on assessment, feedback and physicians' clinical performance: BEME Guide No. 7.

Jon Veloski, James R. Boex, Margaret Grasberger … (2006)

There is a basis for the assumption that feedback can be used to enhance physicians' performance. Nevertheless, the findings of empirical studies of the impact of feedback on clinical performance have been equivocal. To summarize evidence related to the impact of assessment and feedback on physicians' clinical performance. The authors searched the literature from 1966 to 2003 using MEDLINE, HealthSTAR, the Science Citation Index and eight other electronic databases. A total of 3702 citations were identified. Empirical studies were selected involving the baseline measurement of physicians' performance and follow-up measurement after they received summaries of their performance. Data were extracted on research design, sample, dependent and independent variables using a written protocol. A group of 220 studies involving primary data collection was identified. However, only 41 met all selection criteria and evaluated the independent effect of feedback on physician performance. Of these, 32 (74%) demonstrated a positive impact. Feedback was more likely to be effective when provided by an authoritative source over an extended period of time. Another subset of 132 studies examined the effect of feedback combined with other interventions such as educational programmes, practice guidelines and reminders. Of these, 106 studies (77%) demonstrated a positive impact. Two additional subsets of 29 feedback studies involving resident physicians in training and 18 studies examining proxy measures of physician performance across clinical sites or groups of patients were reviewed. The majority of these two subsets also reported that feedback had positive effects on performance. Feedback can change physicians' clinical performance when provided systematically over multiple years by an authoritative, credible source. The effects of formal assessment and feedback on physician performance are influenced by the source and duration of feedback. Other factors, such as physicians' active involvement in the process, the amount of information reported, the timing and amount of feedback, and other concurrent interventions, such as education, guidelines, reminder systems and incentives, also appear to be important. However, the independent contributions of these interventions have not been well documented in controlled studies. It is recommended that the designers of future theoretical as well as practical studies of feedback separate the effects of feedback from other concurrent interventions.

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Toward a normative definition of medical professionalism.

H Swick (2000)

In recent years, professionalism in medicine has gained increasing attention. Many have called for a return to medical professionalism as a way to respond to the corporate transformation of the U.S. health care system. Yet there is no common understanding of what is meant by the word professionalism. To encourage dialog and to arrive eventually at some consensus, one needs a normative definition. The author proposes such a definition and asserts that the concept of medical professionalism must be grounded both in the nature of a profession and in the nature of physicians' work. Attributes of medical professionalism reflect societal expectations as they relate to physicians' responsibilities, not only to individual patients but to wider communities as well. The author identifies nine behaviors that constitute medical professionalism and that physicians must exhibit if they are to meet their obligations to their patients, their communities, and their profession. (For example, "Physicians subordinate their own interests to the interests of others.") He argues that physicians must fully comprehend what medical professionalism entails. Serious negative consequences will ensue if physicians cease to exemplify the behaviors that constitute medical professionalism and hence abrogate their responsibilities both to their patients and to their chosen calling.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Open (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2017

Publication date (Electronic): 27 April 2017

Volume: 7

Issue: 4

Electronic Location Identifier: e013821

Affiliations

[1 ] departmentSchool of English , University of Nottingham , Nottingham, UK

[2 ] departmentDepartment of Linguistics and English Language , Lancaster University , Lancaster, UK

Author notes

[Correspondence to ] Dr Gavin Brookes; gavin.brookes@ 123456nottingham.ac.uk

Article

Publisher ID: bmjopen-2016-013821

DOI: 10.1136/bmjopen-2016-013821

PMC ID: 5566587

PubMed ID: 28450463

SO-VID: 0dc1b108-a2e9-4852-8792-7813a74d9135

License:

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

History

Date received : 09 August 2016

Date revision received : 21 December 2016

Date accepted : 15 March 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000269, Economic and Social Research Council;

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ScienceOpen disciplines: Medicine

Keywords: patient feedback,nhs choices,quantitative linguistics

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ScienceOpen disciplines: Medicine

Keywords: patient feedback, nhs choices, quantitative linguistics

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What does patient feedback reveal about the NHS? A mixed methods study of comments posted to the NHS Choices online service

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Abstract

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Most cited references 30

Patient satisfaction: a review of issues and concepts.

Systematic review of the literature on assessment, feedback and physicians' clinical performance: BEME Guide No. 7.

Toward a normative definition of medical professionalism.

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Cited by 23

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