Working with doctors Working for patients

Principal SOAD - feedback from patients seen only once and those with diminished capacity

You may find this case study helpful if you:

see patients only once or briefly, and/or
see patients who may be more likely to give you negative feedback due to the context or environment in which you work
see patients who might not be able to complete a written questionnaire (for example because they have have mental ill-health, learning disabilities or language issues).

Key points to consider

It's important to collect and reflect on patient feedback for revalidation, whatever your role or specialty. You must collect patient feedback even if you only see your patients once, or have brief patient contact.
Think about how you can adapt the way you collect feedback so you can get responses from patients who you only see once, and from those whose condition may impair their intellectual function, information-processing, or concentration.
Take into account the concerns, needs and context of your patients.
Patients with diminished capacity to respond (such as those suffering from mental ill-health or cognitive impairment) may still be able to give valuable feedback if the process is adjusted to meet their needs. For example, by providing them with help to complete the questionnaire (independently from you) or a questionnaire in a different format.
Make sure your appraiser considers the context in which you work and whether this is likely to have influenced the results. Having your results benchmarked against doctors working in a similar context will be more meaningful, as this will take into account the potential for negative bias in the responses.
Do not collect or collate responses yourself, or ask your Responsible Officer/Suitable Person or appraiser to do this. You will need to use an independent survey provider to process your feedback and give you a personalised report of your results, unless your employing organisation arranges this for you. You should use this report to reflect on what your feedback says about your practice and discuss this at your appraisal.

Scenario

Second Opinion Appointed Doctors (SOADs) are one of a panel of specialists who provide a statutory second opinion on the proposed treatment for patients detained under the Mental Health Act. If the patient lacks the capacity to consent, or refuses treatment, treatment can be given compulsorily. However, an independent doctor must assess the patient and authorise reasonable and appropriate treatment.

These doctors do not have an affiliation to a hospital, and work on demand across the country in the location where the patient is detained. The doctor is not the treating doctor and they must consult with the patient's clinical team. Following the assessment, the doctor may not see the patient or the clinical team again.

Doctors find it difficult to request feedback because there is often no continuing relationship with patients and colleagues.

These doctors were unable to find any measure to provide independent feedback from patients who they see only once. Their patients may be mentally unwell and getting feedback from them can be challenging. They were also concerned that the feedback might be overwhelmingly negative, as the patient might see the doctor as instrumental in them receiving treatment they would prefer not to have.

Doctors undertaking this role as their sole or main medical work, were concerned they would be unable to gather patient feedback to reflect on for their revalidation.

Meeting our feedback requirements

The Principal SOAD (a post equating to a medical director) at the Care Quality Commission, which provides administrative support to the Second Opinion process, explained that research on patient feedback showed meaningful results could be obtained from detained patients, including those significantly unwell or learning disabled.

Using the GMC questionnaire as a starting point, separate question banks for patients and for colleagues were developed. The questions reflected the values and principles set out in Good medical practice (GMP). The questions were structured so as not to require a continuing doctor-patient relationship.

An easy read 'answer on a postcard' system was developed which could be left with the patient by the doctor who visited. Along with instructions on how to complete the card, it was highlighted that the feedback was anonymous, and an advocate, friend or nurse could help them to complete it. Completed cards would be sent, freepost, to a survey provider to process the results.

After successful piloting, a commercial company experienced in other multi-source feedback measures was contracted to administer the feedback process. Results for each doctor were turned into a web based report with numeric, graphical and textual data. Hopefully, they were able to benchmark the doctor against similar doctors so they could compare themselves to others working in the same context.

A doctor's willingness to gather feedback, place it in context and reflect on what is says about their practice has a greater importance than the content of the individual responses. This approach showed that SOADs can collect patient feedback, which can provide valuable material for their appraisal.