Doctors (and patients) should take “TripAdvisor” style patient feedback seriously
BMJ Quality and Safety
It’s as good as formal surveys for capturing what it’s like on the ground
Doctors and patients should take unsolicited online patient feedback about healthcare services seriously, because it is as good as formal surveys for capturing what it’s really like on the ground, finds a large comparative analysis of both approaches.
Rather than dismissing it, doctors should use it to improve the quality of care they deliver, while patients should use it to guide their choice of hospital, say the researchers from Imperial College London and the University of California at San Francisco, USA.
Their outline findings, which will be presented at the 17th International Forum on Quality & Safety in Healthcare in Paris today (Friday 20 April 2012), are published in full in BMJ Quality and Safety.
The Forum, which this year was themed around solutions for tough times, is jointly organised by BMJ Group and the Institute for Healthcare Improvement, both of which are committed to improving quality and safety in healthcare.
The researchers looked in depth at just under 10,000 unsolicited online posts from patients rating the care they had received at 146 acute general hospital trusts in England throughout 2009 and 2010.
The views had all been posted on the government funded NHS Choices website. Among other things, this provides a facility for patients to rate and score the NHS services they have received, including whether they would recommend a hospital to a friend, and four quality domains.
These domains concern the hospital’s cleanliness; whether they were treated with dignity and respect as an inpatient; how involved they were in decisions about their care; and whether hospital staff worked well together. .
These scores were then compared with those provided for the same questions by 68,500 patients responding to the formal 2009/10 Inpatient Survey.
This is a yearly paper based survey, which asks a random sample of patients what they thought about the quality of care they had received while in hospital. Its findings are used by England’s health and social care regulator, the Care Quality Commission to assess performance.
Data on expected deaths, deaths from high risk conditions, and emergency readmissions within a month of discharge were also collected for each of the hospitals, as patient ratings tend to mirror these clinical outcomes.
Comparative analysis showed that the online ratings significantly matched those provided by the formal inpatient survey on all four quality domains and the proportion of patients willing to recommend the hospital to a friend, which was two thirds (67.4%).
Furthermore, the strength of association between the online ratings and the clinical outcomes was at least as strong as that for the formal survey results.
The authors suggest that their findings are “reassuring” because “TripAdvisor” style feedback is probably capturing overlapping but different groups of patients, and therefore different dimensions of hospital quality and performance.
“These results do not prove that one method is better than the other, but they do help us to understand how they compare,” write the authors. “Our results show that despite fears by providers and hospital administrators that rating sites would offer mostly criticisms, rating of hospitals in England are largely positive,” they add.
And they go on to say: “Although online feedback mechanisms should not replace patient surveys, they may provide information on hospital quality that is relevant, complementary to survey data and potentially useful for patients when making choices about their healthcare.”
They conclude: “Healthcare providers and purchasers [of care] should therefore promote the development of such online reporting schemes and encourage their use.”
