A week or so back we did one of our Impact Workshops with staff from Nottinghamshire Health Care to explore with them how they could get maximum value from Patient Opinion. Thanks to their enthusiasm it was a great day and I think we all got a long way. One of the things we did was to invite them to tell a story of their own and to think about the kind of responses that they would like to receive as patient or carer.

Of course this generated a range of stories about health care across Nottinghamshire from GPs to acute trusts and everything in between. A week later and we’re beginning to get responses from the local providers all of which is food for thought.

Firstly I think it was really valuable – as it always is – for people to experience what it is like as patients as well as staff. Getting people to write stories is a great way to put them in touch with what ‘patients and carers’ - that’s all of us when we’re not getting paid – really want.

Secondly it was great to see so many responses from so many providers.

Finally looking at the responses made me realise once again just how self absorbed the NHS often is. Here’s an example of what I mean:

Recently attended gynae with my wife to have the devastating news that she had miscarried again. Even though this was early stages and common, we were made to feel it's just nature. My nursing background and experience accepts this. However not so for my wife. The news was devastating as her hopes had been shattered again.

In the consultation follow up by the nurse I felt she was just ticking the boxes. There was some empathy "I think" but it felt it was all a matter of course. The experience left us both numb with a bitter taste. I feel this outcome will make the next experience even more stressful if bad news is received again.

This is how the acute trust responded:

I understand that this must be an extremely upsetting and distressing time for both you and your wife. I would like us to look into the concerns you have raised fully and properly. Without knowing the full details we are unable to do so. Please could you make contact with me directly

I'm not picking on this trust in particular as in many ways this is a thoughtful response. It is also typical of what many trusts do. But in effect it is saying 'do it our way or we can't help you'.

From the general public’s point of view it is also confusing: given that the problem is clearly stated – this couple felt a lack of sensitivity in dealing with their miscarriage – why do you need any more information? Surely the thing to do is simply to take this story to a team meeting and spend 15 minutes really discussing it. What must the couple have felt like? What kind of words might staff have used? How could we do this better? How would we ourselves like to be treated if we’d just miscarried? And then post an authentic, human account of this discussion as the response from this team does.

Moving away from ‘who, what, when’ to ‘let’s get on with doing this better’ strengthens teams rather than focussing on blame. It also frees the NHS to take responsibility for actively improving itself without asking the patient for yet more help. Being patient-centred is not about insisting things have to be done the NHS way. It’s about delighting patients and families by really listening to them, learning from them and then responding with both heart and head.

[If you’d like to know more about our Impact Workshops do get in touch with us]

Dorothy Armstrong's thoughts on apology generated a real buzz at our recent Glasgow event.  We're delighted that she's agreed to write this blog.

‘We are all human – we can all make mistakes.’

This quote is from a man whose son died. He brought his complaint to the Ombudsman, he said, to ensure that he was listened to, lessons were learned and to receive an apology.

In my role as Professional Adviser to the Scottish Public Services Ombudsman (SPSO), I hear first hand from patients, relatives and carers about negative experiences of healthcare. The most common emotion expressed is of vulnerability, helplessness and humiliation.

When I read the stories shared on Patient Opinion, the themes are very similar to our experience at the SPSO. We see poor communication, behaviour and attitude as the most significant factors in the complaints we receive. In many cases, people feel that they have not been listened to. They feel patronised and powerless. If only staff involved in a mistake or wrong doing, had been honest and open and provided an apology at the time, they would not have continued to complain.

‘An apology is the superglue of life. It can repair just about anything.’ 

New South Wales Ombudsman, (2009).

As children, we are programmed to say sorry for our mistakes, but, in our working lives as adults, saying sorry is a real challenge. When used well in the NHS setting, an apology can be both very powerful for the patient and empowering for staff.

Sorry made easy - The 3 R’s

You can use this tool at work and at home. I’ve found it particularly effective with my teenage children – take a deep breath and try it too!

Regret

It is important to recognise that something has gone wrong by acknowledging the wrong doing, even if you are not at fault. Saying sorry, in a meaningful and sincere manner, is crucial. Often this first step is enough to de-escalate the situation.

Reason

Even if you feel criticised and hurt, it’s really important to provide a reason (if there is one) for the mistake, but to avoid being defensive. Make sure you are clear that the wrong doing was not intentional or personal, so try to keep to the facts. It can help to put yourself in the complainant’s shoes and step back from the situation. Stay objective.

Remedy

Try to resolve the mistake there and then, if you can. Ask the complainant what they would like to happen and take responsibility to investigate, if required, and to provide feedback to them as soon as is practicable. Encourage colleagues to be proactive too.

Dr Dorothy Armstrong is Professional Adviser to the Scottish Public Services Ombudsman.

The SPSO’s Guidance on Apology sets out what an apology is and what you can do to make it meaningful.

For many people the NHS is like marmite, but whether we love it or hate it, we all end up using it one day, one way or another.

Students are one of the most outspoken, actionable social groups around, so when asking a number of them for their opinions on health services – an outspoken answer was what I got.

It has been an interesting few days hearing student’s thoughts on their health services. Below is a film the students I met, sharing their views – but not everyone was happy to be filmed, and as you’ll read below, there were quite a range of views!

International students, on the whole told me that they thought the NHS was great. When asked why, they mostly replied, ‘because it is free and available to all’. Interesting, a majority of the international students I spoke to also felt open minded to the idea of reforms and privatisation of the NHS.

In comparison, British students were a little more sceptical. But, overall they also agreed that the NHS was a great thing, although they did say that there are improvements to be made – all of which can be done with the help of patient feedback.

Elizabeth Etheridge who is studying French at the University of Sheffield, told me how her Nan had recently been in hospital but she felt the only reason ‘things were being done quickly’ was because her mum ‘knew the right people and could pull a few strings’. However, when speaking of the University health service, she could not speak highly enough, ‘fantastically well run, great service and really pleasant doctors.’

Interestingly, when I asked her about her thoughts on Patient Opinion, she said, ‘I’ve never heard of it but I think it’s a great idea. Change always starts from the bottom.’

One group of students I have been eager to speak to are medical students. Fortunately, I did manage to speak to a few outside the University Information Commons on Wednesday.

Although they didn’t wish to be filmed or be directly quoted, they did speak to me and pass on some really intriguing information. One male student who was in his fourth year of medicine told me of how he was intending to leave the field before he had even started because of ‘all of the bureaucracy’. His course mate told me she would be sticking with it but was sceptical of her future as she said, ‘the NHS isn’t what it used to be’. She also told me how all the medical students she knew were in uproar over the current proposed changes.

Speaking with students about their experiences of health services and their thoughts on the NHS, has made me see that students do care about their services and would like to see change. What is more important I think now, is that a site such as Patient Opinion try and expand its reach to students. Students are the next generation and with their strong political ideologies and desire for change, their work and interaction with PO could be surprisingly influential.

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.

Good to have some evidence about what we’ve long suspected – that patients know what they’re talking about when it comes to the quality of hospital services. Researchers at Imperial College have shown that hospitals that  rated highly by patients on public feedback sites are indeed better that those that are rated badly by them.

Not surprising but very worthwhile to have the academic evidence. Thanks to everyone at Imperial who did the hard work.