Background:

Online customer feedback has become routine in many industries, but it has yet to be harnessed for service improvement in health care.

Objectives:

To identify the current evidence on online patient feedback; to identify public and health professional attitudes and behaviour in relation to online patient feedback; to explore the experiences of patients in providing online feedback to the NHS; and to examine the practices and processes of online patient feedback within NHS trusts.

Design:

A multimethod programme of five studies: (1) evidence synthesis and stakeholder consultation; (2) questionnaire survey of the public; (3) qualitative study of patients’ and carers’ experiences of creating and using online comment; (4) questionnaire surveys and a focus group of health-care professionals; and (5) ethnographic organisational case studies with four NHS secondary care provider organisations.

Setting:

The UK.

Methods:

We searched bibliographic databases and conducted hand-searches to January 2018. Synthesis was guided by themes arising from consultation with 15 stakeholders. We conducted a face-to-face survey of a representative sample of the UK population (n = 2036) and 37 purposively sampled qualitative semistructured interviews with people with experience of online feedback. We conducted online surveys of 1001 quota-sampled doctors and 749 nurses or midwives, and a focus group with five allied health professionals. We conducted ethnographic case studies at four NHS trusts, with a researcher spending 6–10 weeks at each site.

Results:

Many people (42% of internet users in the general population) read online feedback from other patients. Fewer people (8%) write online feedback, but when they do one of their main reasons is to give praise. Most online feedback is positive in its tone and people describe caring about the NHS and wanting to help it (‘caring for care’). They also want their feedback to elicit a response as part of a conversation. Many professionals, especially doctors, are cautious about online feedback, believing it to be mainly critical and unrepresentative, and rarely encourage it. From a NHS trust perspective, online patient feedback is creating new forms of response-ability (organisations needing the infrastructure to address multiple channels and increasing amounts of online feedback) and responsivity (ensuring responses are swift and publicly visible).

Limitations:

This work provides only a cross-sectional snapshot of a fast-emerging phenomenon. Questionnaire surveys can be limited by response bias. The quota sample of doctors and volunteer sample of nurses may not be representative. The ethnographic work was limited in its interrogation of differences between sites.

Conclusions:

Providing and using online feedback are becoming more common for patients who are often motivated to give praise and to help the NHS improve, but health organisations and professionals are cautious and not fully prepared to use online feedback for service improvement. We identified several disconnections between patient motivations and staff and organisational perspectives, which will need to be resolved if NHS services are to engage with this source of constructive criticism and commentary from patients.

Future work:

Intervention studies could measure online feedback as an intervention for service improvement and longitudinal studies could examine use over time, including unanticipated consequences. Content analyses could look for new knowledge on specific tests or treatments. Methodological work is needed to identify the best approaches to analysing feedback.

Study registration:

The ethnographic case study work was registered as Current Controlled Trials ISRCTN33095169.

Funding:

This project was funded by the National institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 38. See the NIHR Journals Library website for further project information.

Article history

The research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 14/04/48. The contractual start date was in November 2015. The final report began editorial review in October 2018 and was accepted for publication in June 2019. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors’ report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.

Declared competing interests of authors

John Powell declares current membership of the National Institute for Health Research (NIHR) Health Technology Assessment and Efficacy and Mechanism Evaluation Editorial Board (2005 to present), of which he is chairperson and editor-in-chief (since April 2019). In addition, John Powell is a co-investigator on another NIHR Health Services and Delivery Research (HSDR)-funded project, which was funded under the same call [Understanding how frontline staff use patient experience data for service improvement: an exploratory case study evaluation and national survey (HSDR 14/156/06)]. Louise Locock declares personal fees from the Point of Care Foundation (London, UK) outside the submitted work. In addition, Louise Locock is principal investigator on another NIHR HSDR-funded project, which was funded under the same call [Understanding how frontline staff use patient experience data for service improvement: an exploratory case study evaluation and national survey (HSDR 14/156/06)]. Sue Ziebland declares her work as programme director of the NIHR Research for Patient Benefit programme (2017 to present). Sue Ziebland is also a co-investigator on another NIHR HSDR-funded project, which was funded under the same call [Understanding how frontline staff use patient experience data for service improvement: an exploratory case study evaluation and national survey (HSDR 14/156/06)]. Sue Ziebland is a NIHR Senior Investigator. We acknowledge support from the NIHR Oxford Collaboration for Leadership in Applied Health Research and Care at Oxford Health NHS Foundation Trust for salary support to John Powell, Anne-Marie Boylan and Michelle van Velthoven.

Disclaimer

This report contains transcripts of interviews conducted in the course of the research and contains language that may offend some readers.