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.

If you havn't yet seen it, our director James Munro wrote a great peice for The Guardian this morning. It's a gentle but optimistic warning about the problems the Government might encounter as they bring in a ratings system for care homes. Worth a read, even if we do say so ourselves.

James' peice for The Guardian - "Beware of the pitfalls of rating care homes" (15/12/2011)

"In times of change the learners will inherit the earth while the knowers will find themselves beautifully equipped to deal with a world that no longer exists."- Eric Hoffer

So GPs don’t like on-line feedback. At least that’s what a report in yesterday's Observer said. At Patient Opinion we were particularly interested in this as we are just beginning to pilot how the PO system could be used with ‘consenting’ Clinical Commissioning Groups (CCGs) who have asked us to put their GP services on the system as well as using us to inform their commissioning decisions.

The article was based on figures released by NHS Choices which showed that over the last 2 years 28,000 people have posted comments about their general practice via the NHS Choices service. Some 2,000 of these were not published because they did not meet the editorial policy whilst the same number – 2,000 – of responses from staff had to be withdrawn because they were deemed to increase rather than decrease disagreement between the parties.

From our point of view both figures are extraordinarily large. At Patient Opinion we would expect to have to removed very many fewer stories (around 3 per 10,000 stories) due to swearing, profanity or racist comments. And whilst we don’t prohibit NHS responses, and certainly recognise that in many instances they are woefully inadequate, ones that are aggressive enough to make us think about asking them to be taken down are vanishingly rare.

So what is going on? An obvious answer is that general practice is just starting out on its learning curve about how to handle negative comments on line. But perhaps it is also the case that practices feel more strongly precisely because they sit in their communities and the relationship with patients is – or at least feels – different to them? And last but not least GPs of course have long had trhe option to ‘throw patients off the list’ as a last resort. So maybe this lowers the threshold for them being less courteous on-line.

Interestingly the very early results from our pilot with practices although showing many positive stories also has a significant number of negative ones – accompanied by some very good, sensible responses. So maybe another key variable is when websites are explicit about working with professionals rather than doing to them, as perhaps NHS Choices does

One of the goals of the NHS Future Forum was to put accountability and patient involvement at the forefront of how hospitals and trusts operate.

The web has already transformed the business world, changing our relationship with sectors such as music, journalism, advertising and retailing and it’s just begun to have a similarly transformative effect on healthcare.

Fifteen years ago the only way to publicly raise concerns about local health services was to get a letter or story published in a newspaper.

The web has changed all that. Everyone from the high street retailer to the local hospital can be held accountable in a public, on the Internet. Through social media anyone can blog, tweet, or post a photo of a dirty ward on Flickr.

All this shifts power away from institutions and towards citizens – but having a voice is not the same as being heard. Without engaging busy staff, the angry just shout louder while the quiet folk leave.

This puts the onus squarely on health services to proactively interact with patients in an authentic and engaging way, and with the wealth of tools available thanks to the internet and rise of social media, there is no way they can shun this responsibility, while maintaining public credibility. 

We all know that the experience of being a patient is central to understanding the effectiveness of services, and how they can be improved. And the web is becoming a vital tool for listening to patients.

On Patient Opinion we ask patients and carers to share their stories of recent health care experiences with other people. We publish them for anyone to read and learn from. We tag the stories, and link them to the relevant part of the NHS system so that health care providers and commissioners can easily find feedback about their own local services.

The health service can register for free with Patient Opinion, to be alerted to relevant stories and if they want respond public, and even showing when a service improvement has been made as a result of a story.

When a patient shares their story online, there are no pre-set questions, so they can talk about what is important to them. This freedom is not allowed in the standard patient satisfaction survey, and allows patients to raise issues of which staff may be entirely unaware.

As a case in point, the following posting was contributed by a man on an orthopaedic ward in Northampton Hospital:

“I liked the love, care and attention of every member of staff, it was terrific.

“What needs improvement are the toilet seats. Those on the wheelchairs and those fitted to the home toilet, they are useless. They are only made for women, men cannot sit and urinate and open their bowels as men’s genitals will not sit inside the opening. This means one has to [sit down to use the toilet], then stand and turn to urinate. With a knee/hip replacement operation it becomes like mission impossible. I spoke to eight other men who agreed.”

Five top tips, to help health services make the most of online feedback

This article was first published by the Health Service Journal on 15th Spetember 2011