Andrew Lansley highlights role of iWantGreatCare in NHS

Health Secretary Andrew Lansley has announced that measuring the quality of care delivered by the NHS will be focused on the experience of patients.
In an interview with The Daily Telegraph, Mr Lansley said patients would be asked: "Was the service and experience you had good or not?", and variants of this metric will be fundamental to assessments of standards across all primary, secondary and community services.

Highlighting iWantGreatCare as an organisation leading the way in both collecting and openly sharing such metrics - to the benefit of organisations, doctors and patients - the Secretary of State identified end of life care and paediatrics as examples of the importance of putting the perceptions of patients, families and carers at the centre of drives to improve quality and reduce variation.

Paediatrics and palliative care are of course two of the areas in which iWantGreatCare has pioneered the role of real-time, open feedback of patient experience - delivering improvements in staff morale and service quality as a direct result.

Working with hospitals and community providers across the NHS and private healthcare, iWantGreatCare enables organisations to truly understand the experience of their patients in a directly comparative way - whilst at the same time giving the public the ability to make an informed choice about where they are cared for. Reviews of individual doctors give real power to the public in choosing the type of doctor they would prefer, ensuring that the very best doctors are highlighted and recognised for their huge commitment to patients.

“We’ll be undertaking a consistent national survey of the bereaved relatives of people who received end of life care. Asking them, after a suitable passage of time, what was their loved one’s experience of care and how well were they looked after towards the end of life.”
[We will] ask children about their experience. So 5 to 16-year-olds would be part of this, with their parents, so for the first time we’ll be measuring as part of the outcomes, the children’s experience of their care.”

Rt Hon Andrew Lansley, 7th December, 2011

Professional and independent sites identify the “bad apples”

For those trying to find a good solicitor or lawyer there is, as yet, nothing equivalent to iWantGreatCare.

However, the approach (and technology) used by IWGC has been identified as key to creating a quality service that would benefit both the public and the legal profession:

“The idea of an impartial forum not sponsored or linked in anyway to the Law Society, where people can seek justice for disgraceful advice from a lawyer has its merits. Set up professionally and moderated independently, this kind of facility could help stamp out the bad apples that give the legal profession a bad name”

Being impartial, moderated and professional are at the heart of the IWGC vision. We believe that only by making such principles core to everything we do can the service help patients find great care, and at the same time help doctors and organisations ensure excellent patient experience.

Conference speech: transparency, experience and quality care

The Secretary of State for Health invited Dr Neil Bacon, Founder of iWantGreatCare, to share the stage with him last week asking him to speak on the role of transparency of outcomes, patient experience and choice in improving UK healthcare.

Since 2008, iWantGreatCare has helped shape the agenda in enabling the NHS to harness the power of patient experience - and is the only service that enables Commissioners and Trusts to capture quantitative and qualitative feedback in real time across all inpatient and outpatient services. Thus it is exciting to see this position of understanding and thought leadership being recognised not only by the Secretary of State, but also by those Trusts now deploying the IWGC system to ensure excellent patient experience, and to meet the needs of consultant revalidation.

Public to get much more information on GPs

Longstanding concerns about the variability in performance of GPs “have reached new heights” according to the Guardian. They cite the evidence that nearly half of all complaints about doctors to the GMC concern GPs (who only make up a third of UK doctors), and that negligence claims against GPs are soaring.

These concerns, combined with the Government’s drive for choice and transparency are driving initiatives to give the public much better information on which to choose their family doctor. A range of data will soon be available to help people ensure they are choosing the best doctor for themselves and their family and to help doctors themselves know just how well they are performing compared to their peers.

The NHS Medical Director, Sir Bruce Keogh, has told GPs that patients should be able to get information about the performance of their own doctors:

"The NHS is owned by the people of this country, who are its shareholders, and at times its reluctant or distressed customers. People are now their own bankers, their own travel agents and their own checkout cashiers. They expect to have data immediately available to make choices.”

Empowering patient choice and highlighting the very best doctors who do so much for their patients is of course at the heart of the iWantGreatCare vision. We will be combining the forthcoming NHS data on GPs with our unique, detailed ratings and reviews from patients to ensure that both patients and doctors can see who is delivering great care.

Do you have a great doctor? Let others know by adding a review of them now on iWantGreatCare - it takes less than two minutes and gives you a public way to say thank you for all their hard work.

Why and when should doctors respond to reviews?

Earlier this year iWantGreatCare introduced the ability for doctors to post responses directly to reviews and comments about their care.

This was something that had been requested often but interestingly is less used, than asked for, by doctors (so far). The initial responses made by doctors have all been made to patient reviews that were less than positive, or raised concerns and misunderstandings. The responses made so far by doctors have been excellent: open, honest and engaging. It is clear that the best doctors appreciate being able to respond instantly and directly to patient concerns and in a way that is transparent to the wider public. Not only does this impress and build confidence with the individual patient who provided the initial review, but it also provides an innovative way to increase trust amongst those who are due to see that doctor, or those who are trying to make a choice about which doctor to be referred to.

However, there is a larger opportunity which the best doctors and organisations will I am sure increasingly use and that is to add comments and responses to a whole range of reviews - not just to those that highlight problems or concerns. Outside of healthcare those organisations that really get how to engage and build a relationship with users know the power of responding not only to “complaints”, but also to positive comments and general feedback.

Of course, it will not be practical to respond to every piece of feedback, but the occasional “thank you, glad to hear things are going well”, or “I’m glad your experience of the hospital was good, let us know if there is anything more we can do”, is a) the right thing to do and b) will make a huge and real difference to the perception of those making a choice about where they go for care.

iWantGreatCare makes it easy and quick for doctors to securely respond to reviews they receive.

Doctors - start using IWGC today

Quick guide to benefits (for you and your patients) of using iWantGreatCare.

Choice in healthcare empowers the public

The Cabinet Office and the Government’s office of Fair Trading recently held a seminar looking at the importance and role of services like iWantGreatCare in helping the public get better services, including healthcare. The resulting report outlines how and why such an approach is good for the public and creates healthy competition - as well as considering concerns.

iWantGreatCare is used as an example of ways to increase competition and choice in healthcare.

“...consumer choice in public services will only bring benefits if that choice is informed and effective. Active consumers switching from poor performing providers to those that offer better service or value for money can contribute towards growth through increased efficiency in the delivery of public services.”

Baroness Finlay - IWGC: “the results are astonishing”

Baroness Finlay, Professor of Palliative Care at Cardiff University and a crossbench peer, this week wrote an article for the Times, entitled “Solve the attitude problem and start caring”.

Cutting through the noise and politics of the NHS reorganisation in England she states “a dynamic, systemic way to get feedback on the patient’s experience needs to be embedded in every aspect of the service...services need to know what they are doing well and what they are doing badly.”

Baroness Finlay describes how she has embedded real-time, continuous patient experience in the palliative care system across Wales and states that

The results are astonishing.

The “astonishing” work in Wales, as well as the other examples described of a changing culture in the NHS, were delivered by iWantGreatCare.

Why?

Why do we need a new approach to using patient experience?

Patients and the public want to know they are getting great care.

(and existing systems do not make it possible for patients to identify and choose the very best care)

Doctors and nurses deserve to get regular, comparative feedback on the care they give.

(but only a tiny percentage of those working in the NHS get timely, personalised, comparative feedback on how the great work they do is perceived by patients)

Organisations need to be fully and continuously aware of the quality of all the care they deliver if they are to become world-class.

(this ensures excellence is recognised and disseminated, and poor care is identified before patients are harmed)

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.