Why online patient feedback is essential for NHS safety and quality

How useful is online patient feedback? Are patients really telling us anything we need to know about the quality and safety of healthcare? James Munro dives into this often-overlooked source of information

CREDIT: This is an edited version of an article that originally appeared on BMJ

If you listened to some healthcare staff, you’d be forgiven for thinking that online feedback was a waste of time—or worse. A 2019 survey of medical and nursing staff presents a slightly less negative picture, with around 39% of doctors and 74% of nurses feeling that online patient feedback might be useful in helping the NHS improve services.

Another study offers a different perspective, suggesting that patients are reporting important things about the safety of care that staff don’t know about or are failing to tackle. The study analysed more than 146,000 stories retrieved from Care Opinion, a non-profit feedback platform for health and social care.

The researchers used a machine learning model to detect stories that reported safety incidents. Qualitative analysis of the incidents in these stories showed that many were either unobserved or unresolved by staff, with patients apparently posting online as a last resort.

Poor safety culture

A poor safety culture is increasingly recognised as a contributor to failings in NHS care. Patients and carers are free of institutional ties and the influence of organisational culture. Their reports are independent and unbiased by any knee-jerk defensiveness. Instead of being dismissed by staff as the aggrieved rantings of the discontented, unsolicited reports on the quality of care from outside an organisation should be given greater weight by staff whose own judgment is inevitably compromised by their insider status. Sadly, we are still some ways from seeing patient feedback valued as it should be. In some parts of the UK, where policy and leadership have supported a system wide approach to inviting and responding to online patient feedback, there is growing acceptance that this is an important part of fostering a more open, less defensive culture.

In England and Wales, progress is far more uneven, and there are many healthcare providers still apparently content to ignore online feedback completely or respond in ways which are banal or uncomprehending.

Despite this, a growing number of healthcare staff are engaging more openly with online feedback and finding, perhaps to their surprise, that there are worthwhile benefits. Patient feedback should be welcomed for the insights it can offer, particularly when it comes to staff blind spots or failings in institutional culture. This conclusion is strengthened by other research showing that online patient feedback is predictive of Care Quality Commission inspection ratings in England.