PhD student and staff nurse Liz questions the ethics behind collecting patient feedback if services don’t change or improve as a result
Mentoring students has always been an enjoyable experience for me despite the vast amount of paperwork that needs completing.
Last week I was faced with a new piece of documentation, a feedback form for patients or relatives to evaluate the performance of my student.
This is to ensure patients have a say over how attentive, sympathetic and helpful they were when delivering care.
As far back as 1984, Benner advocated a holistic and qualitative strategy to evaluate advanced nursing skills (Benner, 1984). The Francis report (2013) has shown us in sharp detail the dire results of not listening to patient feedback, a reminder of how vital it is to gain valuable insights into the lived experience of a hospital stay.
“I wondered if patients are swamped by feedback requests when they perhaps want to be left alone to recover”
Despite the altruistic intentions, it made me wonder about power dynamics inherent in organisations and if patients are swamped by feedback requests when they perhaps want to be left alone to recover.
I wonder about the less vociferous and cognitively impaired patients who struggle to have a voice and how possible it is to ‘cherry pick’ our responses.
Patient feedback is highly contextual, Proctor (2002) and Lukes (1974) describe power within organisations; not only the treacherous and direct exertion of power described by Kitwood (1997) but insidious power dynamics which include controlling the agenda itself without anyone realising it is happening.
For example, how easy is it for a 90 year old person with no knowledge of the internet to submit an online feedback form?
I attended a benchmarking session recently to assess the efficacy of pain relief within the trust and to gain patient feedback. Admirable and commendable you may think until it becomes clear that such a task is not as simple as one may think.
“It can be very tempting to make a beeline for patients who are easy to communicate with”
Patients present with cognitive impairment, English as a second language, mental health problems, communication and learning difficulties all of which require a sensitive, intelligent and time-consuming approach.
Very tempting to make a beeline for patients who are agreeable and happy, easy to communicate with and ready for discharge.
Who would you choose under extreme time pressures?
If we do not have the power to change services once feedback is obtained, how ethical is it to burden our patients until we are really able to make that change?
Is good practice such a slippery concept that we have to ask patients to state the obvious, namely, that we should be kind and thoughtful?
“I fear that nursing is in danger of being reduced to the completion of mandatory forms”
Have we as a profession become so blinkered and far removed from the kaleidoscopic role of the nurse to reduce ourselves to robotic, nonsensical ‘box tickers’ with the organisational caveat that we are, after all, accountable?
I fear that nursing is in danger of being reduced to the completion of mandatory forms, where tasks are only seen as valuable if on the priority list we have created for our profession.
We need to get back to basics, discard the superfluous and instead of hearing our patients we must listen to them in creative, intelligent, thoughtful and genuine ways to get to the very heart of what they need from us, and only then strive for meaningful change.
Unless we actively seek out the disenfranchised, the powerless, the people who remain in the shadows of the very service we provide, change will happen only for the more fortunate in society.
“We have a responsibility to improve services, not a right to demand patients’ opinion only to squander such a golden opportunity”
Any change will be in danger of being reduced to a tokenistic nod to user driven services instead of a genuine move towards a true bottom-up approach and a bespoke service tailored to the needs of patients.
Patient feedback is a precious gift; we have a responsibility to improve services, not a right to demand their opinion only to squander such a golden opportunity.
Unless there is the economic and political will to change services towards true patient centeredness, it is in danger of being reduced to a parlous state justified only by the congruency of partnership working under the parsimonious tagline, ‘It’s what patients want’.
Benner, P. (1984) From Novice to Expert. California, Addison-Wesley.
Kitwood T. (1997) Dementia Reconsidered: The Person Comes First. Buckingham: Open University Press.
Lukes, S. (1974) Power: A radical View. London, Macmillan.
Proctor, G. (2002) The Dynamics of Power in Counselling and Psychotherapy: Ethics, Politics and Practice, Ross-on-Wye, PCCS Books.
Liz Charalambous is staff nurse at Queens Medical Centre, Nottingham, and a current PhD student