What's the problem with patient experience feedback? A macro and micro understanding, based on findings from a three‐site UK qualitative study

Abstract

ContextCollecting feedback from patients about their experiences of health care is an important activity. However, improvement based on this feedback rarely materializes. In this study, we focus on answering the question—“what is impeding the use of patient experience feedback?”MethodsWe conducted a qualitative study in 2016 across three NHS hospital Trusts in the North of England. Focus groups were undertaken with ward‐based staff, and hospital managers were interviewed in‐depth (50 participants). We conducted a conceptual‐level analysis.FindingsOn a macro level, we found that the intense focus on the collection of patient experience feedback has developed into its own self‐perpetuating industry with a significant allocation of resource, effort and time being expended on this task. This is often at the expense of pan‐organizational learning or improvements being made. On a micro level, ward staff struggled to interact with feedback due to its complexity with questions raised about the value, validity and timeliness of data sources.ConclusionsMacro and micro prohibiting factors come together in a perfect storm which provides a substantial impediment to improvements being made. Recommendations for policy change are put forward alongside recognition that high‐level organizational culture/systems are currently too sluggish to allow fruitful learning and action to occur from the feedback that patients give.

How do healthcare staff respond to patient experience feedback online? A typology of responses published on Care Opinion

“…This is congruent with previous research which suggests that staff are often overwhelmed by the amount of positive feedback they receive, making it more difficult to spark meaningful conversation around improvement. 21 Despite the apparent relationship between story sentiment and response type received, the analysis further suggests that strong, and more complex organisational influences are at play, with organisations often typically responding according a certain response type, or response types. This may be also influenced by the subscription model which organisations adopts when paying to use Care Opinion.…”

“…16 NHS organisations receive patient experience feedback from a proliferation of tools, and in a variety of formats which can be overwhelming for staff. 21,43 By directing patients to one localised service, the process may become less personalised, but much more manageable. 16 For example, many responders direct patients to the PALS or complaints teams.…”

“…Research into more traditional forms of feedback suggests that the extent to which staff meaningfully engage with these forms of patient experience is highly variable in practice. [21][22][23][24] Issues include staff responding defensively, ignoring or being reluctant to believe feedback, and viewing patients as inexpert, distressed or advantage-seeking [25][26][27][28] . Staff may also believe that directing resources to patient feedback may conflict with the effectiveness or efficiency of clinical care, or cause duplication of work.…”

“…Staff may also believe that directing resources to patient feedback may conflict with the effectiveness or efficiency of clinical care, or cause duplication of work. [29][30] Additionally, feedback may also have limited relevance beyond very specific aspects of care 31 , or reach staff months after the care was provided 21 , making learning less transferable and the wider workforce more difficult to engage. [32][33][34] Despite these challenges, research on the whole suggests that clinicians are generally open, receptive and enthusiastic to learn from patients, but often perceive to have insufficient autonomy or inadequate resources to enact change based upon it, particularly when change is not easily achieved within current systems or ways of working.…”

Reflection in practice: How can patient experience feedback trigger staff reflection in hospital acute care settings?

“…Patient and staff experiences provide important insights into care quality, but health systems have difficulty using these data to improve care. Evidence suggests that organizations struggle to manage the data they collect and to make improvements based on patient experience feedback, and that clinicians often fail to change their practice based on patient experience feedback. One particular challenge in acting on patient experience feedback is that, when patients express dissatisfaction with their care, they often identify problems with staff‐patient interactions .…”