Two weeks ago we held a very lively North of England stakeholder event in Sheffield. And, in the course of what was a very stimulating and enjoyable day, there was one brief exchange between a speaker and a participant which really made me think.

Jane Danforth, involvement manager at Nottinghamshire Healthcare NHS Trust, was speaking about the impact of Patient Opinion in the trust. And Helen Forrester, the manager of B50, one of the trust's adult mental health inpatient wards, talked about how using Patient Opinion had changed the culture of her ward. (Their slides are available.)

One of the participants asked how many stories the trust received through Patient Opinion. Jane pointed to the figure on the slide - "259".

"Oh, so 259 per month?"

"No", said Jane. "259 since we started."

The questioner - and one or two others - looked rather taken aback.

And that was the moment the proverbial light bulb above my head went on. That was exactly the point: it wasn't that Helen had seen significant changes in her ward culture despite there being only 259 stories across the trust. It was that just 259 stories (and many fewer specifically about ward B50) on a public web site had been enough to help her change the culture in important ways. That was all it took.

Of course, everyone (including me) is used to thinking that we need thousands of responses to surveys to tell us anything reliable. But here were worthwhile changes in culture and practice in the wake of a much smaller number of stories.

The point was underlined later in the day, when Steve Eastwood, a commissioner of drug and alcohol services in the North West, talked about how the stories they had received through Patient Opinion were helping them commission better services. (Slides available.)

How many stories? 78.

So there's the question: how many stories is enough? And, of course, we know the answer: enough for what?

It all depends on what you want to achieve. What are your objectives? Why do you want to hear the experiences of patients and carers?

If your objective is to measure (as it so often is in the NHS, where "listening" and "measuring" seem to be used almost interchangeably), and compare those measures between times or places, then yes, you will need a lot of responses to gain the precision and certainty you need.

But if your objective is to change culture, empower patients, prompt staff reflection, or improve services, then on the evidence of Jane, Helen and Steve it seems that a very much smaller number of stories - coupled with an understanding of how to use them - may be more than enough.

At last, I'm starting to understand why we talk about the power of stories.

Philip Dylak, Director Nursing at Tameside Hospitals NHS Foundation Trust, spoke about his practical experience of working with Patient Opinion at our recent stakeholder event. In this guest blog post, he sums up the key themes.

Tameside Hospital's involvement with Patient Opinion goes back a number of years, originally to a region-wide initiative to encourage trusts across the North West to make use of online feedback. At the time, Tameside Hospital was getting some adverse press coverage, and we wondered whether online comments from patients and carers would make matters better - or worse?

It soon became clear that it would be up to us. Early on, we took the strategic view that if someone places a comment about our services in the public domain, on Patient Opinion, then they expect and deserve a response from the organisation. We've followed that approach ever since, with the support of the executive team, and we're absolutely sure we were right to do so.

In fact, I'm proud that in the latest Dr Foster hospital guide, Tameside Hospital was in the top 5 hospitals responding to patient comments online.

There seems to be an attitude of anxiety or indifference to online feedback in parts of the NHS, but we've found that by following some simple principles, it isn't hard to create constructive public exchanges with our patients. So here are my top tips for working with online feedback:

• No stock responses. Unless you are certain it is appropriate, don’t use phrases like "Please contact our complaints department or PALS". After all, if people can access Patient Opinion's website, they can access your own website, and post comments to PALS or complaints for themselves.
• Make the response personal. It's the right thing to do – online communications don’t have to be cold and functional, and a personal response will encourage more people to post.
• Deal with the issues. Don’t give a bland response. If someone praises staff, tell them you will bring it to staff’s attention – and make sure you do. If someone refers to a current problem, such as a service disrupted by building works, don’t be coy – acknowledge it. Your response will inform other people too.
• Say what you will do. Or better still, say what you have already done.
• Timing is all. Respond within 2 days. This may allay anxieties for other people who may have the same issues. We keep an ongoing log – no posting is on for more than a week without a response.
• Use the data. There are tools built into Patient Opinion, or you can pull the data into your own systems. Use stories in training sessions about communications or service improvement, to be sure you know what your service users think about your services, to offset unjustified criticism, and as part of your Trust’s overall understanding of user perceptions.
• Actively engage online. We piggy-back messages onto our responses, for example about our improvement activities. The team at Patient Opinion will give you more tips and help you get the most from it, if you ask.

So that's it - it isn't rocket science, and it isn't as much work as you might imagine. As a director of nursing, I'm one of the busiest people on the planet. If I can do it, so can you.

Philip Dylak.

Slides of Philip's presentation

Patient Opinion's mission is to carry the experiences of patients and carers into the heart of health services, where they can make a real difference both to how staff feel about their work, and to the services they provide every day.

Sometimes our progress feels painfully slow, but this week two things really lifted my spirits - and then something else brought me straight back down to earth.

The first lift came from Devon, where the Royal Devon and Exeter Foundation Trust is just getting underway with Patient Opinion. Instead of just setting up one or two staff to receive all our email alerts, they've decided to set the ball rolling right across the surgical directorate.

So that's 80 senior members of staff at the trust, new to Patient Opinion, and all standing by and waiting to hear from their patients and carers. Impressive commitment to the new world of social media!

The second lift was from the other end of the country, where we saw this exchange follow feedback about the Scottish Ambulance Service.

After an unhappy experience in the ambulance and A&E, the patient posted their concerns on Patient Opinion. The service was able to respond online, reassuring the patient that raising these issues would not compromise their care - which is, of course, one of the most important barriers to honest feedback.

The patient was reassured, and has since met with the service face to face, posting on Patient Opinion that: "I felt comfortable and free to say what I needed to and I feel very validated and understood."

I love this story not just for the happy ending, but because it shows how conversations which can't begin in person can begin online, continue face-to-face, and finish up online again.

So what brought me down? A call to Patient Opinion from someone with a serious long-term condition, a longstanding user of services at a well known teaching hospital. The patient had had a poor experience at one of the hospital's clinics. They sent in a written complaint, but received no response, so after a month they posted their story on Patient Opinion.

It wasn't long before the phone rang. It was a member of staff at the hospital, who refused to give their name. The patient was told: "Withdraw your complaint, or we will withdraw care."

We still have some way to go, it seems, before some health service staff see patient experience as a gift from which they can learn.

Today we saw a lovely example of how quickly and efficiently someone can take patient feedback, and use it to make things better.

A few days ago a patient with coeliac disease posted a story about how they were taken aback to be charged over £40 at the pharmacy for items "prescribed" by the community dietician.

Today, Helen Wyatt from NHS Rotherham responded on the site to say that this might have been an error, and for the author to get in touch to sort things out.

An hour or so later, Helen posted again to report that the primary care trust had updated the voucher form used by dieticians, to avoid a similar mistake happening in the future - making the service better and clearer for everyone, just like that!

Hey, you think I'm going to let myself be outdone on video? No way!

So here's me speaking at Nick Marsh's excellent recent Service Design Thinks evening.

Ten times as long, but only twice as embarrassing (to me, anyway).

James Munro, Patient Opinion - Service Design Thinks 3 from Nick Marsh on Vimeo.