August 13th chat – Patient Feedback

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Post by Colin Hung

High performing operating cultures are continually striving for improvement. Continuous improvement requires continuous feedback – candid, timely, honest, constructive.

University of California, Berkley

Healthcare needs high performing teams. High performing teams not only need feedback, but strong leaders to create an environment where feedback is welcomed and acted upon. Open and honest feedback, however, is hard to come by – especially patient feedback. Yet as healthcare drives toward patient-centered care, feedback from patients and their families is more important than ever.

This week on #HCLDR tweetchat (Tuesday August 13th at 8:30pm Eastern Time North America), we’re going to explore the topic of patient feedback.

  • T1: What can healthcare leaders do to encourage/facilitate patients & families to provide more feedback?
  • T2: Is there a right way and a wrong way to provide feedback (ex: social media)? Is there a right/wrong way to respond?
  • T3: How can healthcare organizations do better/do more with the feedback that’s collected? What can be improved?

Patient feedback – complaints, compliments, suggestions, observations – is extremely valuable. Not only can it give context to a particular point-in-time (or specific event), but taken in aggregate it can also shed light on potential systemic issues within a healthcare organization. James W. Pichert, PhD, Professor of Medical Education at Vanderbilt University, member of that university’s renowned Center for Patient and Professional Advocacy (CPPA) and a man who I respect a great deal, does an excellent job at explaining why feedback is so critical to healthcare organizations. According to Pichert, feedback can identify:

  • Areas of increased risk (liability)
  • Areas of patient dissatisfaction (reputation)
  • Systems issues (quality/safety)
  • Disruptive professionals (reduce staff dissatisfaction)

You can read more about feedback and how it can be used in his presentation “Why patient complaints (and low rating) are important

Pichert along with Dr. Gerald Hickson (also of CPPA) have done a lot of research in this area and have developed a system that can identify healthcare practitioners who are at greater risk of malpractice based on the feedback they receive. You can read more on the CPPA website.

One of the greatest challenges for healthcare leaders is to collect honest feedback from patients and their families in a timely manner. Many patients are afraid to openly criticize the care they receive during their visits/stays – fearing reprisal from their caregivers. This of course is a somewhat irrational fear, especially to the growing number of ePatients and patient advocates who believe that speaking up is the only way to ensure that your voice is heard. But I believe that the average person in a hospital or visiting their doctor prefers to stay quiet rather than give honest feedback.

So what can healthcare leaders do to encourage patients and their families to give feedback? How can they overcome this fear?

Kingston General Hospital, a leading hospital in southwestern Ontario led by CEO Leslee Thompson (a valued member of the #HCLDR community), is using Patient and Family Feedback Forums to encourage feedback. Below is an explanation how this innovative forum works.

During a 30-minute forum, care teams and other staff hear directly from patients and/or their families about a recent experience on a particular unit at KGH. The forum opens with a 15-minute talk in which the patient or family member shares their health-care story. They then leave the room and a facilitator encourages a discussion among staff about what contributed to a positive experience and what could be done to make the experience better. Suggested solutions are summarized in a letter of thanks to the patient or their family to let them know which changes will be initiated.

You can read more about KGH and these Forums in this great KGHConnect post.

Another great example of how healthcare providers are pro-actively soliciting feedback comes from Nemours, a children’s health system – their story is documented by The Beryl Institute in this fabulous case study. Nemours created Virtual Advisory Councils – an “online community consisting of families who experienced Nemours and are willing to help.” The councils are run on Yammer.com – think Facebook for corporations – so patients can freely write their feedback online and see responses directly from Nemours staff. This real-time feedback has proved to be very valuable to Nemours leadership.

Responding to feedback is difficult – especially if that feedback runs counter to your own perspective of the situation (or of yourself). It’s understandable that people and organizations would rather duck for cover than stand and face difficult feedback. Kent Bottles, MD describes it best in his article “Tossing Hand Grenades: How to Deliver Feedback in Medicine Today

Delivering a difficult message is like throwing a hand grenade. Coated with sugar, thrown hard or soft, a hand grenade is still going to do damage. Try as you may, there’s no way to throw a hand grenade with tact or to outrun the consequences. And keeping it to yourself is no better. Choosing not to deliver a difficult message is like hanging on to a hand grenade once you’ve pulled the pin.

Many years ago, a mentor of mine gave me some advice about overcoming the fear of feedback. He said, “Colin, just think about how difficult it was for the person to gather up the courage to give you their honest feedback. Just think of how much time they took to craft the message so that it was constructive rather than hurtful. It probably took them an hour to write it…surely you can spend 10 minutes to listen to it.” Sage advice.

The National Health Service in the UK has an excellent guideline for its healthcare professionals on how to respond to patient feedback. Here are their top four tips:

  1. Respond to all comments, good or bad, as it shows you listen.
  2. Welcome all opinions and try not to be defensive or aggressive if they’re negative.
  3. Do not use the same stock response to each comment. If anything, this looks worse than not responding at all.
  4. Take anonymous comments as seriously as named ones. Just because someone has chosen to comment anonymously, it doesn’t mean that the comment is malicious. A good way of approaching anonymous comments is to suggest the user visits the practice to talk in person about the issues they’ve raised.

One final thought. The proliferation of Social Media tools like Twitter, Facebook, Yelp and Blogs has given patients and their families a multitude of channels through which to provide feedback. These tools are booth a boon and a bane to healthcare providers. Healthcare organizations are still searching for the best way to respond to feedback from these new social media channels. Some are tackling it head-on, but many others are still waiting on the sidelines. I think that ignoring these channels is no longer a viable option…what do you think?

Please join the #HCLDR community on Tuesday August 13th at 8:30pm Eastern Time (North America) for our chat on Patient Engagement. Everyone is welcome.

Resources

“Patient & Family Feedback Forums – new care initiative” Kingston General Hospital  http://www.kghconnect.ca/news/patient-care/patient-and-family-feedback-forums-a-new-kgh-care-initiative

“Best practice – responding to patient feedback” NHS  http://www.nhs.uk/aboutNHSChoices/professionals/healthandcareprofessionals/your-pages/Pages/good-practice.aspx

“Patient Experience, Outcomes and Participatory Medicine” Journal of Participatory Medicine  http://www.jopm.org/opinion/editorials/2013/02/07/patient-experience-outcomes-and-participatory-medicine/

“Why patient complaints (and low rating) are important” James W. Pichert, PhD  http://topics.cme.ufl.edu/files/2012/03/Pichert.pdf

“Engaging with Patients and Families by Creating a Virtual Advisory Council” – Nemours via The Beryl Institute  http://www.theberylinstitute.org/default.asp?page=CASE0613

“Why Rating Your Doctor is Bad for Your Health” Forbes  http://www.forbes.com/sites/kaifalkenberg/2013/01/02/why-rating-your-doctor-is-bad-for-your-health/

“Doctors can reduce malpractice by being better people” KevinMD.com  http://www.kevinmd.com/blog/2011/01/doctors-reduce-malpractice-people.html

“Tossing Hand Grenades: How to Deliver Feedback in Medicine Today” Kent Bottles, MD  http://www.kentbottles.com/pdfs/Tossing-Hand-Grenades-How-to-Deliver-Feedback-in-Medicine-Today.pdf

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