I recently had the privilege of being in a teleconference with Mike Alverson, the CEO of Kaiser Permenante, one of the biggest integrated providers of health care in the States.

One of the interesting things he said was that Kaiser now divided health care into 4 settings:

• - Staffed beds. This includes hospitals and residential settings
• - Ambulatory care by which they mean clinics, out patients, pharmacies etc
• - Domiciliary settings where the patient is looked after in their own beds
• - The web – email and skype consultations, telemedicine, appointment booking, shared decision making and other information aids and your own personal EPR

This made me stop for lots of reasons. Of course! The web *is* a major setting for health care. And one that is rapidly evolving and effecting the other three. And - just like PO - the web is an intrinsically egalitarian place to do health business.

All this is not just happening in California where Kaiser is based. Whether it is giving feedback about what happened to you via Patient Opinion, booking your own appointment on Choose and Book, using your own EPR via Patients Know Best, or exploring patient-founded sites like MoodScope, the web is already becoming a major place for patients across the UK.

I began as an intern at Patient Opinion three weeks ago and have learnt a lot working alongside Kate Ebbutt, learning how the organisation works and how our old friends, Facebook, Twitter and Blogging can help to redesign the way patients interact and gain feedback from their health services. Since starting, I have found myself straying from the entertainment section, to now searching the society and health section of the Guardian website, hoping to find out more about how a health service I always took for granted actually works.

Patient Opinion has told me that patient interaction and feedback is essential to improve services. But I’m interested in why this works. Right now, the NHS is owned by all of us – we feel pride in it (as the #welovethenhs campaign last year showed) and we want it to be great. I can’t imagine wanting to share my story, hoping to make shopping at Tesco better – but somehow it works for the NHS. We feel ownership, and that ownership makes us want to help the NHS. If the health service becomes more commercial – would we still feel that way?

The NHS Reforms have quickly become a real interest for me.The Health and Social Care Bill has fast become one of the most contentious pieces of legislation in British history. Their main proposals seem sensible; to create an independent central NHS Board which keeps an eye on spending across the country, to promote patient choice, and to reduce NHS administration costs. According to proposals, funding and commissioning local health services for patients will no longer be handled by Primary Care Trusts; instead they will be overseen by groups of GPs. However, as this is a new skill for them, GPs will need help – and this help often comes in the form of private consultancy and management companies. The concern is that this will encourage more privatisation and commercial competition.

Criticism of these changes stems from the fear that new reforms would enhance private investment, at the cost of patient welfare. Competition has become the most controversial NHS proposal by the coalition. It is fantastic for business, where it drives quality, but can the NHS be regarded as a business in which competition will flourish? As Doctor Sohom Das remarks, ‘One only has to look at the outcome of the privatization of rail services - dire quality and ever inflating fares’.

I personally feel that it is us, you and me, who make our health services great. Our engagement with the services, sharing our experiences and working collectively to make a difference is key. The question is: would we still feel like this about an NHS that expects us to act as customers, not citizens?

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.