Select Committee on Health Written Evidence

128. Evidence submitted by Dr John Hyslop (PPI 11)

Patient Centred Feedback, A Voice for Each Patient

  1.  To be effective quality management/clinical governance needs be aligned with the clinical management paradigm but also with the patient. Quality cannot improve without feedback. Patients and peers should be able to inform clinical team leaders of good and bad services.

  2.  The current feedback/survey tools are non-specific, post-dated, selective and drip down, rather than directed to the point of managing service change, the clinical team leader.

  3.  The proposal is anonymous electronic patient feedback via domain portals associated with the Electronic Health Record. The feedback is specific to that episode of team service, being identified through Healthspace or Choose and Book.

  4.  Feedback is a tool to place quality central to service delivery imbedded where the commissioners' money goes. The final common denominator closest to patient care delivery is the clinical team and therefore the emphasis in delivering all feedback and the quality agenda should be at this dynamic level.

  5.  As a benchmarking exercise the patient perspective can also inform fellow patients, commissioners, and the Healthcare Commission.

  6.  Patient complaints generate a lot of work and consume enormous management and clinical time. This could be improved by some integration with patient feedback.

  7.  Human interaction and resolution is led through dialogue. Feedback formally creates that dialogue where it might not exist. It is "offer and response" as in any negotiation and as such engages the patient, the individual, with the service. That engagement at clinical team level will influence the good to do better and the bad to change their game, not least because the dialogue is on the record and cannot be ignored. Feedback, therefore, is a persuasive tool that permeates all aspects of service delivery not just as a point of reference but also as a flag of quality of care.

  8.  The relationship created is constructive, gives voice and responsibility to, whilst engaging with, the patient.

  9.  There are thus benefits for the patient, the service, each team and subsequent patients.

  10.  The patient benefits:

    —  Gives each patient a voice, guaranteed to be heard.

    —  Other patients can review service choices alongside a feedback graphic.

    —  PALS are supported.

    —  Engages the individual patient.

    —  Good and poor services can be commented on.

    —  Individual views can be raised in an anonymous format without stigmatisation.

    —  Patients would know that their feedback is on the record to influence service development.

    —  They can become engaged in an active dialogue to resolve issues.

    —  Values the patient's perspective.

    —  Enhances the patient role beyond representative "expert patients".

  11.  The service gains:

    —  A tool to integrate quality, clinical governance and management into clinical team service delivery.

    —  A Feedback summary, informs PAL's, team leaders, institutions, the commissioners and the Healthcare Commission.

    —  The feedback and actions arising are on the record.

    —  Feedback on services can be audited.

    —  Clinical governance is integrated with robust evidence at each team level.

    —  The role of patient advocates and PALS is supported.

    —  Discreet and separate from but informs critical incident reports and complaints.

    —  Good and poor services will be highlighted leading to best management through clinical governance.

    —  Issues that might generate complaints could be actively managed with a timeline of evidence and process.

    —  Norms of service will be determined (benchmarking).

    —  Clinical team leaders' actions and response to feedback will be on the record.

    —  Professionals will spend time on feedback, practice reflection and audit of practice.

    —  Institutions will have a record of quality, of a benchmarking of services teams and professionals.

    —  Teams will know what patients think of their service.

    —  Feedback can generate an active engaged dialogue to resolve issues.

    —  Creates a non-adversarial routine patient-centred quality initiative to influence service quality, delivery, professional practice and healthcare commissioning.

    —  Foundations of an evidence-based constructive complaints system and process.

  12.  The professional gains:

    —  Professional feedback can be noted within the appraisal folder informing revalidation.

    —  Complaints should have a feedback record/timeline for reference.

    —  Past feedback can support responses to complaints.

    —  Professionals will spend time on feedback, practice reflection and audit of practice.

    —  Professionals can contribute to resolve issues and influence local services to improve.

    —  Feedback files are "associated" with the professional, the team and the institution.

  13.  The clinical team leader benefits by:

    —  Allows quality to drive the change agenda.

    —  On the record feedback of good and poor delivery.

    —  On the record service change response to feedback.

    —  Helps guide team meetings and service change planning.

    —  Enables immediate response to issues or poor service.

    —  Feedback and responses/changes are on the record with clear justification.

    —  Teams will know how their service and professionals are perceived.

  14.  The current mish-mash of delivery of quality and clinical governance reflect its non-core position and lack of integration. The positioning of patient feedback as an anonymous tool at the level of the clinical team leader will integrate clinical governance into commissioning and delivery.

  15.  How to take this forward? Briefing papers confirm it's within the art of the possible from choose and book episode or healthspace. The concept of patient feedback enjoys support of the Healthcare Commission, Harry Cayton, Marlene Winfield, (Head of Public Engagement Connecting for Health), Richard Jeavons, Monica Clark,(Patient Experience Team), Dame Eve Buckland, and with passing interest by Sir Michael Rawlins and Professor Paul Corrigan. But it is not policy, or funded yet. It is likely to be cheaper and more direct/timely, thus responsive, than current postal patient "surveys".

  16.  There are external models of patient feedback but these are not ubiquitous, contemporaneous, routine, care episode identified and directed to the relevant clinical team leader. A Healthspace feedback domain can be all these things.

Dr John Hyslop

Consultant Radiologist, Royal Cornwall Hospital NHS Trust

21 December 2006

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Prepared 6 February 2007