Primum non nocere- gathering feedback data in the NHS

One of the bits of the internet where I hang out is alive with debate around this comment piece in The Guardian. I would advise you to click through to read it because I can’t give a good summary of how hard-hitting it is but, in summary, it describes a couple who had exemplary service at an A + E department when they suffered a miscarriage but were then very distressed when they received a follow up text the next day asking them to rate their experience of A + E using the NHS’s Friends and Family Test (how likely are you to recommend this service to others: Extremely likely… etc.).

The author imagines an individual involved in the gathering, analysing, and scrutiny of data gathered in this way as “…a faceless man in a suit pointing to a pie chart at a meeting of senior managers and telling his colleagues that customer satisfaction is at a record high”… and speculates that “He’ll probably get a pay rise for improving results”.

It’s fair to say that this piece had quite an emotional effect on me. My wife and I suffered a miscarriage before the birth of our first child and I can only describe it as like a hammer blow to the stomach. I would have gladly chosen the hammer blow instead because hammers to the stomach don’t multiply the pain they inflict on you and deal it to your spouse. And they certainly don’t inflict that same pain on you day after day and through each subsequent negative pregnancy test. So as I read my heart went completely to the couple and what they had been through.

I then found myself torn apart as the piece demolished the methods and purpose of gathering feedback in the NHS since I have dedicated myself to this very thing, teaching myself programming and markup languages, learning the principles of database design and really being consumed in thought pretty much round the clock as to how we can better gather, analyse, and present feedback data in order to improve services.

I don’t wish in any way, therefore, to argue with or criticise the piece. The texts should not have been sent and the pain they caused is very real. However, I would like to highlight the existence of many strands of work relating to patient feedback. Text surveys may well have their place for particular individuals at particular times (I see a hepatologist yearly, for example, I would respond very well to a follow up text after each appointment).

There are many dedicated people working with patient feedback data, not just faceless bureaucrats; I work with many people who, with me, truly believe in the power of stories (and, yes, tickbox data) to change services. Good and bad services can improve when they listen to their patients and, although the service this couple received was very good, feedback data can be important in improving poor services (or even setting off alarm bells in very poor services).

For those who are not convinced, please visit my Trust’s dedicated feedback website. We share all of our feedback transparently with the world over the internet and also post all the projects and changes that have come about because of patient feedback. The Friends and Family Test is one small part of the work that we do collecting data. Many in the health service feel it is a poor question or badly calibrated, and I would hate its shadow to be cast over the work that so many individuals at my Trust do, individuals who are passionate about improving services and the lives of the people who use them.

And if you’re still not convinced, tell me why and we’ll do it better.