I have just personally reviewed every opinion posted about NHS Highland on the Patient Opinion website. And when I say personally, I mean personally!  Patient Opinion is one new approach we are taking to encourage patients to feed back.  It forms part of our overall approach to capturing patient experience.  At a time when resouces are tighter than ever some may be tempted to reduce the time they spend on the so called "softer" elements of patient care.  But in my view it's more important than ever that we listen to our patients.

I am delighted that staff are taking it so seriously.  In response to one of our recent stories a Head of Service commented, "Thanks for sharing this with me too.  It's always good to get feedback and it helps us to make improvements that make a difference to patients.  it was great to see lots of staff being appreciated not just the Consultant!"

A patient who raised an issue on Patient Opinion about prescriptions alerted us to a problem that we have now fixed.  And having carried out a wider review we have been able to bring about improvements across Highland.

Ultimately we want to get to a position where giving and receiving feedback is as natural as saying please and thank you.  

Online tools like Patient Opinion will help us to listen, respond and improve.  I commend it to you.

Elaine Mead, Chief Executive, NHS Highland

Hi, my name is Jane Danforth. I work as an Involvement Officer for Nottinghamshire Healthcare NHS Trust. It’s a huge integrated mental health, learning disability and community health services organisation covering Local and Forensic services, Community Health services and Offender Healthcare. It’s my first time writing a blog on the Patient Opinion site. I hope you will find it interesting.

I’m really lucky to work in an organisation that supports an Involvement team with two Involvement Centres. It’s true to say I am blessed with great support from the top of our organisation; Professor Mike Cooke CBE (our CEO) my manager and also from Trust colleagues and Patient Opinion (PO)

How can I describe the PO team and what they offer to us? Well, for one, ‘real time’ feedback is starting to change the way we do things in the Trust. 2011 has been the best year for us yet. We were named as Pioneers of the Month for PO last year and we held the record for the fastest posting and response times of any Trust! We get Facebook and Twitter posts about us leading the way for patient feedback and it’s made my job so enjoyable. It has done our Trust the world of good and given us a platform to prove that our ‘Positive’ brand is not rhetoric and spin. PO has made a difference and offered value for money to the organisation. People say how much they like it and find it a great way to share how they feel about our services and what they would like to see get better.

Open and honest feedback sometimes means you have to take a deep breath and think hard about how you are going to respond to stories that are not always complimentary. The support of a great Communications Team makes all the difference. Julie Grant, Head of Communications is my sounding board and someone I can go to when challenges arise. Equally Sam Eagling, managing PALS and Complaints (Service Liaison) helps complete the circle of communication. I know that between us we can help to make things happen and people posting on the site get their voices heard. Things actually can change for the better and we have seen it happen ‘before our very eyes’!

I’m really pleased to say that the majority of our feedback is complimentary. I know staff get a real lift from postings that praise what they do and when we can’t always do what people ask, we can at least explain why some things are the way they are. I really believe it can stop people taking things further when issues arise and over next year we are going to try and evaluate this.

Our involvement volunteers take on many different roles. This year and in 2012 we will continue carrying the Olympic torch for PO.

Our PO Champions are making a difference using a ‘pass it on’ philosophy. Champions are made up of service users, carers, families and staff including Governors. For everyone they tell about PO they encourage others to tell someone else. Word of mouth is a powerful marketing tool, if you are good you can get always get better and positive feedback is a massive motivator. Equally when feedback is not good you have to listen and work together to resolve issues.

Next month I am going to tell you more about our iPad pilot. We launched a trial across the Trust in Local and Forensic services and believe me it’s been an exciting time! To be honest, It has increased my workload initially but it’s also given me such a buzz when I can see staff becoming responders and our youngest ever posting was from a 10 year old using our child and adolescent mental health services and in case you are wondering? Yes it was positive!

In January, we will be looking forward to the year ahead. My manager Paul Sanguinazzi, Head of Involvement, is keen that we really focus on getting a seamless reporting system that pulls together all our feedback in the Trust.

Other Trusts have started to ask me how we work with online feedback and I look forward to February 9th where we have been invited to speak at the regional PO event in Sheffield about how we have made it work for us in Nottinghamshire Healthcare.

And finally, I would like to share with you a letter of thanks that was given to me at the beginning of the week from a patient who was being discharged. This posting made my year: A letter of thanks for the staff on Ward B2

If you had to choose being able to see the name of the person who sent you an email or its title which would you choose? Well the evidence is pretty clear that most of us go for the person not the title. The messenger has always been more important than the message when it comes to getting stuff into our consciousness.

This is important when it comes to writing a good response on Patient Opinion (or any other social media platform). The more personal the responder is, the more feel they feel OK about being visible as the messenger, the easier it will for the reader to hear them. So here is a great response from Epsom and St Helier

We're glad your husband's injury wasn't serious and we'll pass your kind comments on to the team, including - importantly - the 'niggle' about having to give the full medical history twice. As you'd expect, there are procedures in place for staff to check and double-check some elements of a patient's medical history, but you shouldn't need to repeat the full history in such a short space of time.

It’s good because the writer has obviously read and appreciated the original story. And it’s written in a friendly style that makes you think there is someone pretty human at the back of it.

But it could be even better. For a start the author is simply ‘Epsom and St Helier University Hospitals’ which is about as impersonal is it gets. It would be great to know who it was who was saying this stuff – not just their job title but preferably their full name. And it would be even better if we could see what they looked like so its great when people add their photographs to responses just as Jane Danforth at Nottinghamshire Healthcare Trust does .  (it’s really easy for Patient Opinion subscribers  to upload a photo to personalise their responses).

And the worst kind of response that we see? Well that’s easy - it’s the cut and paste job from someone who doesn't appear to have even read the original posting and doesn’t give any details of themselves except their job title. Even worse is where every response from the organisation is identical so that anyone scrolling through a few can immediately see that the worst kind of ‘tick boxing’ is going on.

People are pretty savvy about user feedback nowadays. They are used to reading TripAdvisor and Amazon reviews. They know that some reviews will be from when the organisation – or maybe the author - was having a bad day. They read a few and come to their judgement. But the responses – well now that's real data direct from the horses mouth itself. So judgements may be quicker and harsher -  ‘Look at this - a cut and paste job for this posting that says terrible stuff happened? How heartless can these guys be?’

 On this reading the response to a posting – especially negative ones - may be more important in shaping the public’s perception of a trust than the critical story itself.

It's interesting to see the line of what is ‘permitted’ by NHS trusts around social media shifting. Here’s the Chaos and Control blog – beautifully written by Little Feet – about how her un-named mental health trust prevented her from blogging during a recent stay as an in-patient. But what exactly was the problem that so bothered the mental health trust?

'Given that I wasn’t blogging about other patients and when specific staff were mentioned, they were anonymised, I felt this approach a bit heavy-handed. However, their argument was that patients who were more unwell than me could blog anything, regardless of the truth'

Yes, well that’s true. In a world where everyone has a public voice – i.e. can blog or tweet or post on Facebook – all sorts of people are now able to say all sorts of things about all kinds of institutions. And so? Does that make the sky fall in? No. Is it a good thing or a bad thing? Well I guess that depends on your perspective. But the one thing that is absolutely clear is that public voice shifts power to the citizen. This kind of heavy handed approach by the trust will inevitably back fire. Just ask Mubarak.

Of course some blogs and Facebook entries will be offensive, untrue or malicious (none of which is in anyway true of Chaos and Control). But on the other hand as Claire an OT who is one of our favourite NHS bloggers (@ClaireOT)  cogently argues  self expression is part of getting better, of moving up Maslow’s hierarchy. From a therapeutic point of view, all other things being equal, blogging and using social media should welcomed by mental health teams.And surely it’s all useful data – either about the staff, the service, or occasionally about the person who posts

So a blanket rule of ‘Don’t blog!’ is in our view both misplaced and impractical. What is happening here is that the NHS is (slowly!) learning the realities of the new world of social media. Most of the time social media comments should be welcomed. Sometimes they should be ignored. Occasionally something needs rebutting. For a good guide on all this take a look at the useful  US Air Force process chart on how to respond to blogs which we found on Jeremiah Owyang's great blog 

From our experience of moderating thousands of stories about mental health services we know that occasionally postings will raise issues of clinical governance – for example people expressing suicidal thoughts or threatening harm to staff. But in principle this has always happened and trusts should have procedures to deal with this.The fact that it is now happening in public on-line may be uncomfortable but does not change anything much. At root trusts need to think about whether they are exercising a legitimate duty of care - or protecting themselves.

And if Little Feet would like to use Patient Opinion as a platform to talk about her experience of services we would welcome her story.

Back in 2005 when social media was just getting going I read the Cluetrain Manifesto. It told companies in no uncertain terms about just how different the coming world of informed consumers was going to be. Cluetrain was big, famous and influential. It used this picture to illustrate the way that companies were treating their customers.

Not very Christmassy I grant you but arresting. And if you were being unkind – or had just spent too much time at the Mid Staffs inquiry – you might think that incidental roadkill is exactly how lots of people who have been harmed by the NHS end up feeling.

So our (slightly sombre) Christmas Cracker is a new version of the manifesto re-written for the NHS and updated to take account of social media. (And our thanks, acknowledgements and apologies to the great original.)

A Cluetrain Manifesto for the NHS

People using social media communicate in language that is natural, open, honest, direct, funny and often shocking. Whether explaining or complaining, joking or serious, the human voice is unmistakably genuine. It can't be faked.

On the other hand when the NHS ventures on-line it usually talks in the humourless monotone of a Comms strategy, and the your-call-is-important-to-us busy signal. Same old tone, same old evasions. No wonder people are beginning to lose respect for a health service unable or unwilling to speak as they do.

But learning to speak in a human voice is not some trick. Trusts and Health Boards will not convince us they are human with lip service about "listening to customers." They will only sound human when they empower real human beings to speak on their behalf. This isn’t difficult – some health organisations are already doing it really well.

Twelve Propositions for the NHS in 2012

1. Social media means that the networks surrounding health services are getting smarter, more informed, more organized. Participation in these networks changes people fundamentally.
2. There are no secrets in this new world. Combine open data with democratised voice and whether the news is good or bad, everyone will know it.
3. With a billion people on Face Book the NHS’s attempts at patient engagement and empowerment look increasingly out of touch with reality.
4. The hard-to-reach aren’t 'out there' – they are alive and well and working in the NHS.
5. The NHS is having two conversations. One with itself. The other with everyone else. In most cases, neither conversation is going very well. Almost invariably, the cause of failure can be traced to obsolete notions of command and control.
6. Front-line staff - who make the wheels of the NHS turn each day - want to join these public conversations directly in their own voices, not in platitudes written by the Director of Comms.

Meanwhile what people are thinking online goes something like this:

7. The people we’d really like to talk to on-line are the nurses and doctors who look after us. But you always hide them behind a corporate smokescreen that prevents anyone taking responsibility for the words that come out of their mouths. Don’t you trust them? Or is it us you don’t trust?

8. We already know some people who work for you. They're pretty cool online. Do you have any more like that you're hiding? Can they come out and play? When we have questions we turn to each other for answers. If you didn't have such a tight rein on "your people" maybe they'd be among the people we'd turn to.

9. We’d be delighted if the NHS joined us in this new world of social media. But it's our world. Take your shoes off at the door, start talking human! Even at their worst, our on-line conversations about your services are more interesting than all that corporate flim-flam you’ve been shoving at us since Mrs Thatcher's time.

10. We've got some ideas for you too: some new tools, stuff that will make your services better, and your staff happier. For free, right now. Got a minute?  

11. We'd like it if you got what's going on here. That would be really nice. But it would be a big mistake to think we're holding our breath. We have better things to do than worry about whether you'll change in time to get all this. Health care is important but it’s only a small part of our lives. It seems to be all of yours. Think about it: who needs whom? 

12. To the NHS these networked conversations may appear confused, may sound confusing. But we are organizing faster than you. We have better tools, more new ideas, no rules to slow us down. We are waking up and linking to each other. We are watching.

But we are not waiting.                                                                                                         

                                                                                      Happy Christmas!