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Trust introduces 'live' patient feedback system

A hospital trust in the Midlands has become the first in the NHS to launch a real-time feedback system for patients, with comments posted directly to its website.

Patients, families and visitors to Birmingham Children’s Hospital Foundation Trust can use a free app on their smartphone to post their thoughts, complaints and compliments about the trust immediately.

If it proves a success the project could be a trailblazer for similar feedback applications, as part of a wider plan to increase the patient voice across the NHS.

The feedback app allows an anonymous message to be sent direct to the ward manager in charge who can then address any concerns raised. The message is also publicly displayed on the trust’s website.

Trust chief nursing officer Michelle McLoughlin, who has been leading the project said: “The app enables us to gather feedback in a way that our patients and families want to give it ,so we know immediately what we are getting right and what we need to improve to make their time with us the best it can be.

“Staff have embraced the technology and find it so rewarding to see the feedback from their patients and families and be able to respond straight away.”

She said the app was not a “gimmick” and other trusts could benefit from using it.

One of the trust’s ward managers, Sue Davies, added: “What I think is particularly good is that we can send a reply back to them quickly to acknowledge their comments and let them know what we have done in response.

“It shows that we take their views seriously and they don’t just disappear into a black hole.”

The app has been developed by Digital Life Sciences supported by NHS Midlands and East. It is expected to cost £100,000 over seven years.

It has been trialled on two wards but will now be rolled out across the trust.

The app also features a ratings function, as part of the national Friends and Family test, which allows the trust to analyse emerging themes or issues.

Messages are moderated as they go live on the hospital website to protect staff and patients, and to ensure medical details and offensive language are removed.

Since the project launched, the majority of messages posted have been positive about the trust.

Some have raised concerns including one parent who revealed a mix-up over medical notes involving two children with the same name.

They said: “I am now worried that this could have happened before. I would like all the notes to be checked.”

Another said they were “very disappointed” with the attitude of the triage nurse who the family felt did not listen and “objected to every word we said”.

A response posted a few hours later apologised and asked the family to contact the lead nurse.

Another post said the hospital was “let down badly by a poor planning and scheduling system” in its outpatients department that left families and children waiting too long.

One message typical of many said: “With all the news about NHS standards of care (Stafford hospital) I can only say the care you gave us is completely at the other end of the scale.

“The nursing staff in Ward 10 are exceptional in the lengths they go to administer care in what is a very demanding ward.”

Readers' comments (43)

  • michael stone

    Great !

    I've supported direct real-time patient feedback, as opposed to clinician-designed 'yes/no' questionnaires, ever since the 'family and friends' test cropped up !

    The faster this becomes more widely available than simply apps on smartphones, the better, in my opinion.

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  • what about the many, and especially the elderly or very ill, who don't or can't use a mobile phone? they are the ones most affected by bad care and do not all have somebody to speak out for them.

    re anonymous, how can a complaint be dealt with immediately by the ward manager if it is posted anonymously?

    furthermore anonymous seems to be ill perceive by many here!

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  • Reinventing the wheel. Even at its worst ward 11 at mid staffs received and responded to real time feedback - they just responded inappropriately. All these ideas take time away from time to care. Is trying to get good feedback posted on the hospital screens really the way to nurse?

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  • Anonymous | 22-Feb-2013 12:51 pm

    just another way of showing off your you have a smart phone!

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  • Yes But

    Anonymous | 22-Feb-2013 12:51 pm

    But Mid Staffs didn't have the feedback from patients on open display, obviously - if those comemtns had been public domain, I'm pretty sure it would not ahve taken years to reach a peak !

    There should be a system to allow patients who do not have smartphones to post comments - as pointed out by Anonymous | 22-Feb-2013 12:36 pm.

    I am pondering over 'anonymous feedback' - this one is tricky, but I think you should somehow prove that either you or the relative commenting, was actually in the hospital, somehow ?

    But, as it says, this is 'a start' and to be refined if it seems to be effective, with luck.

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  • michael stone

    I sent an e-mail on jan 29th to the contact address in the F & F guidance the Nobody pointed me at - no reply so far, but this is my e-mail:

    Dear John,

    I was pointed at Gateway Reference 17990 during a discussion, in which the Family & Friends test cropped up.

    I’m not sure exactly what type of ‘feedback’ you personally are anticipated to receive as contact for that document, but I’m very interested in the concept of service users, evaluating ‘the less easily measurable’ aspects of NHS care. Amongst other things, it is possible that some things not greatly valued by professionals might be more highly valued by patients and relatives - however, if professionals design the question(s), those things would probably not be considered within it.

    So I myself, would be tempted to use a different type of question, that is harder to ‘collate’ but provides a more detailed answer:

    ‘We are interested in your experiences. If you feel that you would like to comment on anything particularly good, or particularly bad, that happened to you during your stay here, please explain that to us’

    or something similar.

    I’m interested to understand, why the current proposal seems to concentrate on easily-evaluated methodology, instead of potentially more informative ‘narrative’ feedback ? Admittedly one would need to evaluate action based on narrative feedback on a ‘it led to this change locally, and complaints subsequently dropped locally’ basis – but it does not necessarily follow that the easier-to-compare/collate types of feedback, are the most valuable/informative, surely ?

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  • Sounds good. Can deal with general issues + concerns, but not specific ones as feedback is anonymous. Also no proof they are a patient or relative there.
    Friends + Family Test will give false positives, but I suspect people who implement that already knows. If negative feedback was given, frontline staff who are the ones asking these questions + doing their best, will be very upset + distracted, even if they are too professional to show it.

    Sooner or later privacy + confidentiality will be breached by patients or relatives, for naming others (patients, staff, locations, etc), reporting without permissions of those concerned, on conditions, treatments, videoing, recording, publicizing details through any feedback sites + social networks. Even if they hand write into notebooks, details may not be secure, and if mentions others they'll have a right not to be mentioned or to receive a copy of everything too.
    Frontline staff may feel like they're the ones under scrutiny for doing their job + subjected to harassment when someone thinks things should be done differently. If there's defensive practice now, it feels like it's only going to increase soon.

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  • Oh but it was on open display - it was easily seen by relatives but the culture was such that it was ignored and because it was ignored staff came to see their behavior as acceptable and people were afraid of repercussions if they pushed it. A relative recently told me they were happy to fill in surveys about nurses because they were happy with us but threw the GP one away as they weren't happy and they thought it would cause problems even though it was anonymous. Its usually the most vulnerable who are reluctant to complain - and I can't see this happening with this system. Its just a way of satisfying a tick box that feedback is encouraged.

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  • Bringing smartphones, mobiles, notepads, makes it tempting for opportunistic thieves, in areas of high patient turnover + visiting relatives/friends, especially where there isn't enough staff.

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  • Anonymous | 22-Feb-2013 4:43 pm

    I agree, even with anonymous paper feedback, some people were reluctant to complete + put it into the box themselves. It's not like voting papers where there's a code on every page, and anonymous can be identified to a registered individual (even if someone else fills it in).

    The most vulnerable + sickest patients generally aren't making the loudest noises and would also be reluctant to complain. I bet there been occasions where nurses have answered several call bells, a few to the same patient, only them to realise their quieter patient were deteriorating and only by luck caught it in time, while more bells were going off. I reckon the feedback there would be neglect of patients ringing the bell and not that a death was prevented.

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  • Could there be a worse idea to publicly denounce staff who are already stressed and overworked through staff shortages. Maybe it should be nurses giving public feedback re staffing shortages. Its just more money being spent on things other than front line staff.

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  • Making this app wouldn't cost a lot of money - its just a website on the phone sending details to a database.

    What is important is how much attention will actually be paid to these comments? Its no good simply collecting these and sticking them on the website and ignoring them afterwards. Complaints need responding to.

    My worry is only those that shout loudest will get the attention. Quiet people will just be ignored. And these comments will be on a public website where anybody in the world can view. Which means complaints will also be seen. Supposing a patient complains against a nurse? Will that be published? Who will follow it up?
    Will the trust keep the email addresses and contact details of those who comment? Is this seen as personal information?

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    Gives the latest on the FF test.
    Sadly Mike, this wasn't developed by public consultation, but an expert group (bit like the LCP but for different reasons) and the membership included several mathematicians, which is why it's so quantitative.
    PDaveAngel, it uses QR codes and the trust's Caldicott's rules means that neither staff nor patient details are posted online, so the company who wrote the app use anonymise tigon/ pseudonymisation in a way that keeps people safe but allows them to feedback. We're looking into it in my trust in detail, as well as what the best way to get feedback from our most vulnerable is. Yes, you can measure things like pressure scores and so on, which we already do and nurses have too many forms to fill in as it is, so we're trying to find technology to help take some of it away/ make it easier.

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  • Why not just put us on the stocks, for lynch mob to throw tomatoes and whatever at us...

    The wonderful things about anonymous feedback it could be from anyone, eg trolls, ogres, doctors, nurses, managers, relatives. Along with the right spirit, just don't use a device, email or ip address traceable back to you ;)

    Although patients abuse should never happen, it gets more publicity and reporting than anything healthcare staff do well.
    There has never been a programme as far as I know, highlighting staff abuse in any form. It wouldn't get aired and be down played . People will complain that they didn't give permission to film them punching you with psychotic rage and it was your fault as your face was in the way.

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  • andy

    "Although patients abuse should never happen, it gets more publicity and reporting than anything healthcare staff do well."

    why not find some incidents of 'anything healthcare staff do well" and bring it to media attention, and who knows if they get enough positive stories they may also spread through the media and sway public opinion like an epidemic. Maybe somebody should do a documentary on the 'Day in the life of a nurse' and a 'Night in the life of a nurse' (on a very short staffed large acute ward of course)!

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  • When I was in active work, as a qualified nurse, from early 1970's - 1997, on patient 'feedback', I was told by my senior nurse management , that, '' if you believe anything a patient says, you must be mad''.
    What irony!

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  • michael stone

    Anonymous | 22-Feb-2013 4:43 pm

    Oh but it was on open display - it was easily seen by relatives but the culture was such that it was ignored and because it was ignored staff came to see their behavior as acceptable and people were afraid of repercussions if they pushed it.


    Anonymous | 22-Feb-2013 7:42 pm

    Firstly, one problem with things like the Mid Staffs enquiry, is the separation between 'evidence gathering' and the events - this type of feedback, stored, could be looked back at in the future, precluding any 'nobody ever mentioned this' defences (all too common at present !).

    Secondly, WHY do some nurses assume that all feedback would somehow be 'knocking nurses' ? How do you know lots of peopel wouldn't keep posting 'There were never enough nurses, and they were always rushed off their feet' ?

    Off topic, to The Nobody: I'll post somethign about your maths teaching comment somewhere, because your experience (maths teachers not 'explaining why we do it this way') is precsiely why so many people are scared by maths. Maths is one of those subjects, where you need to udnerstand 'why we are doing it this way' - many people get left behind early on, and then spend the rest of their school life 'desperately plugging numbers into equations, with no idea why'. This is APPALLINGLY BAD TEACHING !

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  • "How do you know lots of peopel wouldn't keep posting 'There were never enough nurses, and they were always rushed off their feet' "

    one could always use bribery.

    helpful comments, better care!

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  • tinkerbell

    'Staff have embraced the technology and find it so rewarding to see the feedback from their patients and families and be able to respond straight away'

    If the staff at this hospital are finding it rewarding then i trust their opinion.

    We have the technology now to improve things - let's use it and cut through all the time consuming bureaucracy.

    All sytems can be abused but

    Most people using the system will be sensible and reasonable one would hope, like ourselves.

    We have to try and trust one another.

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  • Relatives are wonderful and of course their comments and observations are always valid !

    An anecdote !

    A patient was bought by ambulance to an A&E department. She was elderly and had clearly suffered a significant cerebral event.
    A CT scan was udertaken within 40 minutes of the ladies arrival. The scan showed the lady had suffered a large intracranial bleed which was not amenable to treatment.
    When the relatives arrived the situation and the patients poor prognosis was explained in sympatetic terms.
    It was then the problems began !

    The relatives began shouting , screaming abuse at clinical staff, calling Drs usless and stating that we were only interested in "killing" the old lady.

    Regretfully the police had to be involved when staff were threatened with physical violence.

    This maybe an extreme example but during my long career I have known many nasty, viscious and vindictive complaints made some of which are relentlessly persued and often involving lawyers.

    Of course if someone has a legitimite cause for concern attempts should be made to quickly resolve the issue.

    However, with the scandal of Mid Staffs and the ongoing debate surrounding the LCP, many inapproprite "complaints" will be denerated by patients and their relatives.Refuting these "complaints" will result in accusations of whitewashing and tabloid news stories !

    Happliy in a couple of months I will retire I will do so with no regrets.

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