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When is enough data too much?

Question from Care Opinion

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picture of James Munro

I’ve been to two events about patient experience recently. And at both, the same slightly surprising thing happened.

The first was NHS England’s Friends and Family Test conference in March, during “FFT spotlight week”. Tweets from NHS England emphasised the scale of the FFT programme:

But perhaps counter-intuitively the strongest message of the day, emphasised by speaker after speaker, was: "We’re collecting too much data and doing too little with it."

The second event was last week’s conference at the King’s Fund on using patient feedback effectively. Again, the same message came over loudly: stop collecting so much data.

Long ago, I blogged about how much feedback you need to make improvements in care, and why stories and numbers are so different in this respect.

But this possibly emerging consensus that we now have too much data (or maybe the wrong kind of data?), rather than too little, reminded me of something Don Berwick says in this short video on what he calls “Era 3 Healthcare”. The video is just seven minutes long and I urge you to watch it in full.

In Berwick’s list of 9 steps to Era 3 healthcare, the first is this: “stop excessive measurement”. Which sounds familiar.

Berwick goes on to discuss other steps to Era 3 Healthcare which resonate strongly with the mission and values of Patient Opinion: Embrace transparency, protect civility, and listen.

This is an agenda for change which emphasises the intrinsic motivations of committed professionals and the capacity of patients to encourage staff, challenge poor systems and co-design better care. Collaborative, respectful, mutual relationships between patients and staff are key to the effective, sustainable healthcare of the future, Berwick is saying.

At Patient Opinion we share this humane and profoundly relational approach to learning and change. The change we want to see is the change that comes from connecting people, not just collecting data. Patients are energy sources, not just data sources. Healthcare isn't a machine, it's a community.

Given all this, the question now in my mind is: does the Friends + Family Test’s emphasis on collecting industrial quantities of very attenuated feedback now help or hinder our progress towards Era 3 Healthcare?

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Response from Shaun Maher, Strategic Advisor, Person-Centred Team, Scottish Government on

Thanks James.  Reminds of the QI maxim about collecting "just enough" data.  Measurement is not the goal, improvement is the goal. I think the same applies to feedback with the additional dimension of connecting meaningfully.  I think you do a great job at Patient Opinion of helping us to collect meaningful feedback.  Meaningful and measurable with a focus on improvement - now that sounds sensible and doable!

Response from Chris Beeley, Senior Analyst, Involvement, Nottinghamshire Healthcare NHS Trust on

I quite agree. Not only are we collecting too much data, we are collecting it wrongly. Quoting the raw numbers of FFT measurements collected is laughably meaningless. Any statistician worth their salt would immediately ask questions about the sampling method. Sampling refers to the way in which respondents are selected and is absolutely key to the making correct inferences about a population. The most well known example would be the 1948 US Presidential election which nearly every pollster called wrong, all because of inadequate sampling. Closer to home we have all just witnessed the dramatic failure of most polling organisations in the 2015 UK Parliamentary Election.

As for measurement more generally, our own Health Secretary has misrepresented research about death rates at the weekend, and across the NHS huge quantities of data pile up, using inadequate measures, analysed incorrectly, with duplication and omission as far as the eye can see.

The whole field is crying out for a properly designed, conducted, and evaluated approach to measurement which maximises accuracy, minimises data collection and its burden, and which provides timely and simple insights about the way that the whole health system and its constituent parts work. This field, data science and its application to healthcare, is exploding in the US and elsewhere while we in the NHS continue to plough the same furrow, banging the same screws with the same hammer that the guy who did our job 20 years ago left behind.

And yes, those same resources saved and those same insights could be used to spend more time actually listening to patients and actually making the changes they want to see.

Response from Shaun Maher, Strategic Advisor, Person-Centred Team, Scottish Government on

So true! We need to measure less an measure smarter. We also need to broaden our gaze to include all sources of information. Stories are data too.

Response from Jane Danforth, Involvement & Experience Officer, Involvement, Experience and Volunteering Team, Nottinghamshire Healthcare NHS Trust on

Stories are powerful data. We use them extensively in our Trust. Listening then acting on the feedback is key. Powerful feedback usually resonates with the reader or listener and often has an emotional aspect. Some of the best stories are short and low tech.

One of our stories was captured on a 90 second clip of a patient in recovery thanking the staff for changing her life. The film was recorded on a mobile phone. Staff listened, they made a difference, they took time to really hear what she was saying. She recovered and went back to work.

Simple though that sounds, it's not the experience of many people.

PO gives a different dimension to the way we gather and share feedback and really helps us to get to the heart of what we are trying to do when improving services. 

Increasing choice in the way we leave feedback is crucial and using multiple platforms and methods to achieve this works.


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