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.

2 thoughts on “Primum non nocere- gathering feedback data in the NHS”

  1. I too, read the article with sadness and an empathy for the couple who were faced with an automated text in a state of distress. And here’s the conundrum. I also encountered a devastating miscarriage some years ago that left me unable to talk about it for a long time. How I would have felt if a text had been sent at my lowest ebb I don’t know, but on the flip side I am passionate about feedback reaching the right people to bring about improvements.

    I work for the same Trust as Chris.The Friends and Family Test question is not my favourite measure either but we have to ask the question and do as we are told! One question doesn’t provide a rich picture of the real experience. The stories our Trust receive via Patient Opinion are mostly good thankfully but some are bad. Those stories keep us grounded and we want to know about them. The difference with this feedback compared with a rated tick box question is that it is given freely. The author shared a story and their opinion about their healthcare. Changing the culture around feedback in the NHS and promoting a feedback website like Nottinghamshire Healthcare Trust takes tenacity and courage.

    Technology is increasingly sophisticated but as this couple found out, it was cold and impersonal in their time of distress. I like text message feedback for shopping and general polls. It has it’s place in some health services too. There are numerous places where it could and does work but how about a different type of SMS for people who have experienced trauma? I would prefer a text that asks how I am feeling that provides a contact number, helpline or website should they need support after returning home. I can dream…

    In my role at work I recently asked for feedback from carers and families to help us to refresh a strategy. Again, some of the feedback was really helpful and positive but some carers were less than happy to be approached as they had clearly been through some terrible times. The implication was I was being paid a lot of money to be asking silly questions that went nowhere and that is fine by me as they took the time to write and express their disquiet. I remain optimistic and passionate about the changes that can be made by providing feedback. I still worry about those who don’t have a voice and this is what keeps me moving forward. I care and I know the team I work with care and we do it together. We can always be better but we can’t stop trying…

  2. Patient feedback is very important especially those that identify a problem. We can only learn if we know about problems. It is also nice to express thanks to work and care well done and it lifts morale.The friends and family test is useless as you don’t learn anything from a yes or no answer. As expressed it can also be very intrusive at times of grief.
    Work done on patient feedback by Jane and Chris who have both posted has been great for patients.
    Things however are much better now and there are many ways to give feedback and also less fear in expressing it personally. My wife had an ectdomic (don’t know name exactly) pregnancy. it is where the fertilised egg gets stuck in the fallopian tube. It gives a lot of pain and needs rapid hospital treatment.This was in 1969 before we had any children. My wife was put on a ward and was next to a woman in for a normal abortion. We were told nothing did not have any help. We were told bluntly that the chance of having any children was diminished. There was nowhere to complain or talk about your treatment. So let’s be pleased for the internet, blogs, patient opinion. patient feedback, PALs and clinicians that you dare speak to and dare I say it with apologies even the friends and family test.

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