INQUIRE: Improving NHS Quality Using Internet Ratings and Experiences

INQUIRE is a programme of work funded by the NIHR HS&DR Programme that incorporates five studies about the use of online ratings and reviews of healthcare. The issue of online ratings reminds me of my annual car servicing, where following the service I’m asked about the experience and how it could have been better. As the ubiquity of the internet becomes the accepted method of communicating a person’s thoughts and opinions on their experiences of any particular goods or service, it seems like the right thing for the NHS to do too.

So what are the five parts that make up INQUIRE? In short, they are:

  •         What do we already know about feedback from patients?
  •         Do people who feedback have certain attitudes and characteristics?
  •         Why do people choose to feedback or comment online?
  •         How do those on the receiving end feel about the feedback?
  •         When feedback is given, does it change what people do and how they do it?

In retail, online reviews describe many different things: from the star rating for service given in a clothing store, to the often lengthy reviews describing and critiquing items such as exercise machines or kitchen equipment. The first kind tends to benefit the store in assessing the quality of the service given by their staff and can be used for reward or to make changes. The second kind is more often used by potential purchasers of the item as a type of recommendation, (or not as the case may be!). These too can benefit the retailer, but more importantly, benefit others who are looking for some help in choosing a product or service.

In this case, however, we are not discussing retail outlets or online sellers, but the quality of NHS services received by patients and their carers. Health is often an emotive subject and can polarise opinion, so seeking feedback is perhaps tantamount to inviting extreme views. A quick look at any online health review site, like PatientOpinion, NHS Choices or iWantGreatCare, will more often than not, throw up plaudits for a job well done or criticism for the opposite. It seems that there are few (if any) reviews that take the middle ground, saying ‘everything was fine and my care was ok’. Qualitatively speaking, the extremes may provide us with opportunities to improve quality within the NHS. They are a source of critique from the patient’s perspective that offers a unique insight into care experiences.

Choice is the watchword of the modern NHS, but the reality is that there is a paucity of choice. It is dependent on geographical location and the clinicians and allied health professionals who work in that area. So perhaps ratings and reviews are less useful in supporting a model of choice and more appropriately seen as an opportunity to monitor care quality from the bottom up.

As a relatively new endeavour the collection of reviews and ratings of healthcare faces some challenges. We need to find ways of utilising online patient feedback in an appropriate, timely and effective manner. We also need to assess the value it adds. INQUIRE is a starting point for addressing some of these challenges. By consolidating previous work we can describe what already exists. We can learn more about who feeds back, why and how this is received by healthcare staff. These understandings will enhance the current state of play within the NHS when it comes to online patient feedback.

We are a social media obsessed generation, but we are still quite a distance from the volume of the Amazon or TripAdvisor type star-reviewed essays critiquing the product or experience the consumer has purchased. Research like INQUIRE is needed to ascertain exactly what is happening with health ratings and reviews.  In the near future we may have the opportunity to provide ‘real-time’ feedback, without the fear of verbal retribution or compromised care. Where feedback is as simple as a few taps on a mobile phone, or where a live camera feed records your feelings and comments.

I must admit to a guilty secret of reading online reviews of healthcare professionals that I’m due to see, or hospitals in which I have been assigned to be treated. It’s a human thing, to research the unknown, especially if that unknown is about to delve into your most intimate parts! But giving feedback is another thing altogether. I give feedback and I do it because I’ve been brought up in a certain way and because I know that it’s the right thing to do. I do it also because I’m nagged by organisations and people to give feedback. Sometimes I do it because of a reward that’s being offered, but I don’t see the advent of a two for one offer on A&E visits or frequent flyer points for GP visits any time soon!

Douglas Findlay
Chair of Patient, Public and Carer Reference Panel for INQUIRE

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