James Munro: In a pandemic, does patient feedback still matter?

I’ve spent 15 years advocating for the importance of online patient feedback in health and social care. But in the throes of a global pandemic, with tens of thousands of deaths, what’s the point of patient feedback? Is it an unnecessary distraction at a time of unprecedented crisis?

On the face of it, it might well be. In a situation where large numbers of people face the prospect of respiratory failure with no access to intensive care, the quality of healthcare becomes a secondary issue. The primary issue is simply access: who will be treated? Who will get the next ventilator?

But despite a high media profile, only a small proportion of coronavirus-related care right now is intensive care, or ever could be. Far more care is much less visible: advice and information, supportive care at home, mental healthcare, end of life care, and social care. 

Seen in this broader context of highly relational care, patient and carer feedback continues to offer important benefits for both patients and staff, even (and perhaps especially) during a pandemic. For patients, giving online feedback represents a form of “caring for care, a way of giving back to the caregivers. One study found that the most frequent reasons for posting feedback about healthcare online were to inform other patients, to praise the service received, and to help improve standards of care. Now, more than ever, we should be welcoming these practical expressions of active, concerned citizenship.

For staff, patient feedback is often seen as “data” which may or may not help services improve. But increasingly we are learning that the impacts of narrative patient feedback on the culture and performance of clinical teams extends far beyond service improvement, important though that is. For example, a recent case study of the introduction of online patient feedback in a struggling acute trust showed how feedback lifted staff morale, built confidence and restored pride in the service being provided. Again we need this, and more of it, at the present time.

With astonishing rapidity, covid-19 has precipitated a “channel shift” away from in-person healthcare towards remote telephone or online consultations. Whether or not this becomes a permanent feature of the post-pandemic landscape, we need rapid feedback from patients on this new form of care: does the tech work? could you hear me? what would be better? At the same time, the barriers to enabling safe and simple real-time feedback in this context are suddenly much lower, because both parties are already online. After the consultation, just click the link and post your feedback.

Although clinicians tend to be wary of online patient feedback, assuming it to be mainly negative, the truth is the opposite: most feedback is positive. In recent weeks the UK has seen an extraordinary outpouring of gratitude on social media for healthcare staff, and for the NHS as an institution. This appreciation for care has always been there, but social media and feedback platforms such as Care Opinion and nhs.uk have made it visible to everyone.

This matters, because recent evidence suggests not just that patient-expressed gratitude may enhance medical team performance, but also that witnessed gratitude may contribute to the spread of helpful, prosocial behaviours. These are different mechanisms through which publicly visible patient feedback already contributes to better healthcare: not through the provision of “data” but through helping to stimulate the growth of open, positive and learning team cultures. 

Giskin Day, currently pursing a PhD on gratitude in healthcare, recently tweeted her “7 tips on boosting the effectiveness of gratitude to those putting themselves out for others in the coronavirus pandemic.” However helpless we may feel at this moment, as patients and carers, we can at least continue to contribute feedback which encourages staff and improves health service performance. We can all be part of fostering trust, understanding and connectedness in the face of the fear and exhaustion that staff and patients are coping with. Yes, covid-19 is extraordinarily contagious: but so is gratitude, so is kindness, so is hope.

James Munro is chief executive officer of Care Opinion CIC, a non-profit social enterprise which provides an online patient feedback platform (careopinion.org.uk).

Competing interests: James Munro is a paid employee of Care Opinion CIC. See full declaration

Twitter @jamesfm55

For a recent summary of research into patient feedback, see the NIHR themed review Improving Care by Using Patient Feedback.