Smoke alarm to detect poor patient care

Dr Neil Bacon has written a short piece on his personal blog describing how patient experience (the ratings and reviews that patients submit on their doctor and hospital) can act as a “smoke alarm” for patient safety.

When there are 500,000 reviews on iWantGreatCare, UK healthcare will be safer and better than it is now - thank you for making your contribution to that journey.

Citizen power will transform the NHS

An article by Dr Neil Bacon, founder of iWantGreatCare, has been published on the Public Service website. Co-written with Professor David Kerr, advisor to the Government, it describes the unique power that the public and patients have to transform the NHS, and ensure that they and their familes get the very best care.

How can the public properly understand what sort of care their local GP, dentist or hospital provides, let alone be part of a process of improving the quality?

Some would say that sort of improvement programme should be left to the government, hospitals and medical professions. However, evidence suggests otherwise. Perhaps in this case, rather than the doctor, it is the patient who knows best.

In order to start this information revolution citizens need unfettered access to two sorts of information: clinical outcome and performance data (hospital infection rates, cancer survival figures) and the shared experiences of other patients.

Will you be the one in five who gets poor care?

One in five women ‘failed by NHS’ in labour.

This weeks report about the variation in quality of UK maternity services provides yet another example of why patients and the public need to make careful choices about their care - who provides it and where it is is delivered.

But how to find the best care when there is so little information allowing you to compare one hospital or doctor against another?

The views and opinions of other patients and users of healthcare is known to be accurate in predicting where great care can be had - and helping all of us avoid those hospitals that doctors and nurses know to avoid!

This brings with it an obligation on all who use services to provide their feedback: to help the next patient, to say thank you for great care, and to highlight how hospitals can improve what they do.

Doctor-patient communication (again!)

Hospitalized patients and their doctors often have differing beliefs regarding patients' knowledge and aspects of their care, suggesting a need for improved patient-physician communication, according to research published in the Aug. 9/23 issue of the Archives of Internal Medicine.

Nearly all physicians (98%) stated that they at least sometimes discussed their patients' fears and anxieties, compared with 54% of patients who said their physicians never did this (P = .001).

As a doctor if you really want to know if your communication with patients is any good (and where you can improve), then you need to ask every patient and every relative how well you are doing - they will tell you! iWantGreatCare makes this simple, easy and revealing, and can be fully integrated with your appraisal and personal development. Start here.

As a patient, please help your doctor by telling them how they are doing in this respect. All as good as it could be? Then use iWantGreatCare to praise and thank those looking after you.

Over-50s increasingly doing research online

Recent research by the UK Online Measurement Company revealed that the number of Britons using the internet had risen by nearly 2 million in the space of 12 months, with the biggest growth witnessed in the over-50s age group. The charity Age UK advises older people to make the most of the internet, claiming that they could save both time and money by getting online. It also notes that broadband access gives older people "a wealth of information at your fingertips" and - in a brochure produced with BT - recommends use of online comparison sites.

It is interesting how many people in senior health positions across the UK claim that web-based ratings and reviews of healthcare discriminate against the older patient. I wonder where they get that prejudice from?

Peer learning, support and online communities

If you were designing a disease treatment system from scratch, bringing together clinicians, patients, researchers, and advocates, what platform would you use to take advantage of the community created by this umbrella group?

This is the question posed by Susannah Fox of the Pew Internet project. She uses the extended discussion session that iWantGreatCare was part of at Health 2.0 in Paris earlier this year to consider some of the challenges, opportunities and lessons already learnt.

As we move from hospital-based to shared, integrated, community models of delivering services this is a question of urgent importance to all those in the UK.

Take home message: it is not about the doctors or buildings, it is all about the patients.

Embed direct feedback into the system

It’s very flattering when iWantGreatCare gets mentioned in high places and by those who really understand and care passionately about caring for patients.

It’s even more exciting to know that the work the team does, and the way in which iWantGreatCare works together with doctors, nurses and other health professionals, is enabling colleagues to improve what they do on a day to day basis. This is of course the vision of iWantGreatCare - to harness patient experience to drive up quality of healthcare.

Thus being mentioned in the House of Lords recently, counted as a great moment for the small team here and another step on the way to realising our aspirations:

On incentives, we should remember that healthcare professionals are proud. They want to deliver a good service. If you embed direct patient feedback into the system, as we have in Wales for palliative care using iWantGreatCare, it can become a powerful driver to quality improvement. One team does not want to perform less well than another, but patients need to provide feedback in an anonymised way so that they are not fearful that their comments might antagonise the clinicians looking after them.

If you are a patient or carer and wish to help improve the quality of care you (or others) receive, simply go to the iWantGreatCare.org website now and add a review about care you’ve received. It makes a difference.

Putting patients in the driving seat works

Gosh, it’s been an incredibly busy few weeks.

So much for a summer-break, the iWantGreatCare team has been fully occupied helping our existing clients realise all the benefits of real-time, direct patient experience.

One of the fascinating things about enabling organisations to harness patient experience as an outcome metric, is how rapidly it becomes an essential and powerful tool affecting so much of what they do, and how they do it “from ward to board”. This is exciting and satisfying - sort of like letting a genie out of the bottle, but with every one winning (not just the person who gets to make the wish!).

In addition to the Health Secretary Andrew Lansley once again naming iWantGreatCare as an example of patient-centric outcomes which “put patients in the driving seat”, the Department of Health have released their Outcomes document and Health White Paper.

All those who are passionate about high quality care and patients getting the very best treatment, will be delighted by the new focus on outcomes. Most importantly, the measures to be used include those that are reported directly by patients (including experience ratings at a highly detailed level).

This shift from targets to outcomes is long overdue and - if done properly - will benefit every single user and employee of the NHS.

Exciting times.

Harnessing patient experience improves the care patients receive in Wales

The iWantGreatCare team is privileged (and not a little bit proud) to be an ongoing part of an innovative, powerful and important programme that is improving the service and experience of those receiving end of life care across Wales.

Edwina Hart, the Minster for Health and Social Services in Wales states that,

“...good palliative and end of life care must form part of the overall package of care provided to patients when and where it is needed, where ever possible, irrespective of their medical condition.”

There is total commitment and purpose in Wales to make real the intent behind this statement and the work of iWantGreatCare is just one part of an overall methodology and approach. But the detailed statement of the Minister vividly illustrates the central importance and power of continuously harnessing experience feedback from patients and their families.

“This patient feedback [iWantGreatCare] is directly influencing the work of the Implementation Board to steer service strategy for the future and further improve the care patients receive.

The programme provides an opportunity across the whole health economy for relatives to ‘tell us their experience’ when someone close to them was dying, describing both what went well and what did not go well. Its purpose is to share experiences with professionals to enable services to change and subsequently improve future services.”

To make this happen, the iWantGreatCare team worked closely with those delivering care across Wales to put in place a unique system that captures the experience of patients and their carers in a way that has never been done before. Feedback is collected both on and offline (in both English and Welsh) via a seamless, technology-enabled system that sends automated reports to those at the clinical frontline on a regular basis, as well as "instant alerts" that provide immediate electronic alerting when the experience of care falls from the high standards that the teams across Wales have set for themselves.

It is exciting to see that the harnessing of patient experience - when done in an innovative, engaging and evidence-based manner - really can deliver true improvements to the care of patients. In turn this motivates and inspires those delivering the care to reach even higher standards. This is the power of the iWantGreatCare approach: to turn patient feedback from what it has been to date (a routine data collection exercise of "box-ticking and meeting targets") into an active driver for service improvement and quality healthcare where success is measured through the eyes, wishes and needs of patients themselves.

Perhaps the greatest - and most pleasant - surprise of the iWantGreatCare programme in Wales has been the incredible response of the doctors and nurses about whose care the patients are continuously providing "ratings and reviews". Initially cautious about asking patients for comments and ratings, within a few weeks of starting the initiative the detailed feedback on their performance has become something that is highly valued and central to their own assessment of the quality and value of the work they do. The combination of structured, comparative ratings (perhaps the first time that NHS staff have been given continuous, detailed assessment on their performance as viewed by patients), with the qualitative, detailed stories told by grateful patients at a time of great need, has surprised many by its power to renew and refocus the passion they have for their work. It is not an exaggeration to say that staff with many years experience working in palliative care, have not only been moved to tears by the moving responses from patients, but have come to view the regular reports from iWantGreatCare as a central and motivating part of their work.

iWantGreatCare is now working to deliver these same benefits to healthcare professionals (and their patients) across the UK and across all specialties in primary and secondary care.

Transparent patient experience at heart of NHS quality improvement

“We will enable patients to rate hospitals and doctors according to the quality of care they received, and we will require hospitals to be open about mistakes and always tell patients if something has gone wrong,”

The UK Government has made rating of hospitals and doctors - and publishing all this information in a transparent "TripAdvisor for Health" manner - central to the improvements the NHS needs to deliver.


There is strong evidence that systematic reviews and rating of hospitals and individual doctors is powerful in driving quality improvement - and this announcement will be welcomed by patients and all those providers focused on excellence. iWantGreatCare has been working with those providers and commissioners leading the way in harnessing patient experience to deliver quality improvement in a time of financial squeeze, and who have already seen the massive, transformational benefits that such an approach delivers: better care, lower costs, increased staff satisfaction.

For organsisations new to this area there may be many questions about how best to collect this information, how to meet the needs of non-English speakers, offline versus online feedback, information governance and data protection issues etc.

The good news is that all these challenges have been solved and the benefits of embracing patient experience to improve quality are available to all doctors, Trusts and hospitals today - even before the Government make it mandatory.

Using patient experience for improvements to GP out of hours care

GP out of hours care (or the lack of it) is an experience that frequently leads to concerns and negative reviews from patients writing on iWantGreatCare. It provides a good example of how listening closely and carefully to systematic patient experience can inform and highlight concerns before service deterioration leads to patients suffering and adverse outcomes. But of course such an early warning system is only effective if the voice and experience of patients is made central to improving and monitoring the NHS.

Thankfully Andrew Lansley has made reforming the current situation of GP out of hours care an early and clear action for the new Government. This is to be applauded and will be welcomed by the many thousands of patients who each week need quality, compassionate care through the night or at weekends. It will also be welcomed by the huge number of GPs who were opposed to changes which destroyed the UK’s previously excellent out of hours care provision - and who every day see the damage and suffering that second-rate care causes.

It is also worth noting that those doctors who have maintained responsibility and ensured their patients get the very best care out of hours, attract rave reviews, huge praise and thanks from grateful patients and their families.

iWantGreatCare at Health2.0 - Paris

The iWantGreatCare team presented at the prestigious Health 2.0 conference in Paris this week. Neil Bacon, the Founder of iWantGreatCare, gave the first public demonstration of the enhanced real-time reporting and monitoring dashboard provided to our clients and partners. His presentation, below, demonstrates how this gives healthcare providers, insurers and commissioners unique insight into the quality of services they provide, allowing new understanding for rapid, focused quality-improvement programmes.

iWantGreatCare founder gives EU keynote

Dr Neil Bacon, founder of iWantGreatCare, was an invited speaker at the EU's prestigious E-Health 2010 conference in Barcelona last month.

Taking the title, "Citizen 2.0 - harnessing patient experience for better healthcare", he outlined how services such as iWantGreatCare represent one of the most powerful drivers for improved quality, transparency and accountability in European healthcare systems. The presentation, which can be viewed below, focused on the power of systematically collected patient experience data to both reduce inequalities and drive down healthcare costs across all European member states.

"The informed citizen has true choice and creates massive pressure of "market forces" on providers."

Talk - Part 1

Talk - Part 2

NHS monitoring systems

Patient experience - solving the problems of today's failed monitoring systems.

Existing methods of measuring and monitoring NHS quality and safety are repeatedly shown to be slow, insensitive, inaccurate and misleading. The Care Quality Commission relies on expensive, centralised, backward-looking data collection which does not drive the change needed, nor build confidence amongst the public.

After further hospital disasters in Mid-Staffordshire and Basildon (and, we are told, more to come) we need new approaches that actually work and win the support and con?dence of the public, professionals and the media. Harnessing the user-voice to understand patient experience has the ability to:

• reduce costs,
• raise quality,
• empower patients,
• increase safety.

Using innovative technologies (well proven in other industries) makes it easy for patients (and their relatives and carers) to provide feedback in a valid, robust, structured manner, thereby delivering accessible, meaningful information about the things that matter to users.

To deliver this change requires vision, resolve and a willingness to absolute transparency in public services. It will reveal some difficult truths about the variation in quality across the NHS - but ultimately all patients, all staff and all NHS organisations will benefit.

Service improvements or simply closed hospitals?

The NHS needs to save money, Huge amounts of money. This requires fundamentally changing how things are done, not merely making current practices more efficient.

However, whenever PCTs embark on what is claimed to be service-redesign to deliver better, modern care in new ways that also save costs, they are rapidly attacked by their regional media and "angry, local people". For example, NHS Surrey told HSJ:

"...the campaigners were completely focused on “bed closure rather than service improvement” and invitations to come and see how new services were being delivered had so far been shunned."

This is of course not surprising and requires PCTs to re-engage with their public in innovative, open and transparent ways. Again, a whole new way of operating. iWantGreatCare is working with PCTs to address this problem, using real-time patient experience as a "barometer" of opinion, whilst also showing service-users that current structures and services are not only financially unsustainable, but also frequently deliver mediocre patient experience.

Real-time monitoring through iWantGreatCare allows PCTs to demonstrate that patient experience with existing services is far from satisfactory, and then to show that redesign has not led to a worsened patient experience. Only systematic, quantitative systems (implemented before redesign) have the potential to counter the problems that NHS Surrey and others are already facing.

It is hard to tell people their local hospital has to close. It is not quite so hard if you show them that real people - their peers - prefer the new provision and that the solutions deliver happier, healthier patients. That is the level of patient engagement needed not just locally, but also at a national level as we battle to reshape the NHS into a high quality, cost-effective, patient-centric service fit for 2010.

Use internet sites to rate care and prevent abuse, says Dignity Ambassador

Department of Health's Dignity Ambassador urges patients, relatives and carers to use internet reviews and ratings to support elderly care: ‘Sir Michael Parkinson: Blow the whistle on poor treatment of elderly’.

The Daily Telegraph reports how Sir Michael Parkinson, the Department of Health’s Dignity Ambassador for the past year, has being appalled at stories of poor treatment in care homes and the NHS, with the elderly left exposed and unable to eat food put before them. He urged the public to get involved and report unacceptable treatment of the elderly but also to praise staff who go the extra mile and provide care with dignity and compassion. He made specific reference to using quality internet sites which give patients, visitors and carers a new way to record their gratitude or raise concerns of dissatisfaction.

The public must appreciate the very real power that they have in making changes happen at the front line in care homes. This power comes from using internet sites that transparently show the experience of other users, their visitors and their families. This ‘power’ to affect change is, however, not a dictatorial power; it has two important dimensions. Firstly it allows care home staff to have a 360 degree assessment of their performance, adding a vital component to assessing what is good performance and how this should be rewarded and what is poor performance and how this can be actively managed to improve. Secondly, and probably most importantly, the power is in making services better and safer for the elderly. Families and carers continuously rating and reviewing care provides a uniquely sensitive barometer for frontline staff and managers to assess when quality of care is starting to slide. When managers have early access to this information the public rating and review has the power to prevent the often disastrous human impact, and expense, that comes from poor quality care.

This is a new age and provides hope for real improvement. Online, real-time, continuous ratings - with all feedback being openly available - gives families of the elderly transformational power to effect enormous change in the frontline services that are delivered to their relatives. As one famous elderly person would have said, "Use the Force".