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.