I see patients briefly in challenging circumstances. How can I collect feedback?
This case study will help if you:
- see patients once or only for a short amount of time
- work in an environment or context where patients are more likely to give negative feedback
- see patients who struggle to complete a written questionnaire (for example, because of mental ill-health, learning disabilities or language issues).
Key points to consider
- It’s important to reflect on patient feedback for revalidation, whatever your role or specialty. You must seek patient feedback even if you only see your patients once, or for a short amount of time.
- You can adapt your approach to seeking feedback so that you get responses from patients who you only see once, or whose condition may impair their intellectual function, information-processing, or concentration.
- Patients with diminished capacity to respond can give valuable feedback with adjustments, such as help to complete a questionnaire (independently from you) or a questionnaire in a different format.
- Make sure your appraiser considers the context of your work and whether this is likely to have influenced the content of feedback you received.
- Don't collect or collate responses yourself, or ask your responsible officer, suitable person or appraiser to do this.
- Use an independent provider to process your feedback and give you an anonymised report of your results, unless your employing organisation arranges this for you. Use this report to reflect on what your feedback says about your practice and discuss this at your appraisal.
Dr O’Neill is a Second Opinion Appointed Doctor (SOAD), a specialist who provides a statutory second opinion on proposed treatments for patients detained under the Mental Health Act. This is his sole medical practice.
If a patient lacks capacity to consent, or refuses treatment, treatment can be given compulsorily. It is Dr O’Neill’s responsibility to independently assess patients and to authorise reasonable and appropriate treatment.
Dr O’Neill is not affiliated to a hospital, and works across the country wherever the patient is detained. Dr O’Neill is not the treating doctor and must consult with the patient’s clinical team. Following assessment, he may not see the patient or clinical team again.
Dr O’Neill struggles to get feedback as there's often no ongoing relationship with the patients or colleagues. His patients are also frequently mentally unwell, which makes collecting feedback challenging. His feedback is often overwhelmingly negative, as patients blame him for unwanted treatment.
Meeting our feedback requirements
Dr O’Neill’s suitable person told him that research showed it was possible to get meaningful feedback from detained patients, including those significantly unwell or learning disabled.
His suitable person developed a bank of questions suitable to ask his patients. Questions reflected the values and principles in Good medical practice and were structured so that a continuing doctor-patient relationship was not necessary to answer them.
An easy read ‘answer on a postcard’ system was also developed, which could be left with the patient by the doctor who visited, to complete in their own time.
The postcards had instructions and explained that an advocate, friend or nurse could help them complete the questions. It was also made clear that feedback was anonymous and that completed cards could be sent, freepost, to a survey provider.
Dr O’Neill’s suitable person successfully piloted this approach and contracted a commercial company, experienced in multi-source feedback measures, to administer the feedback process. They provided each doctor with a web based summary report, with numeric, graphical and textual data, that compared Dr O’Neill’s results against other doctors working in a similar context.
Dr O’Neill discussed with his appraiser how the context of his work influenced the feedback he received. Dr O’Neill’s suitable person felt that his willingness to gather feedback, place it in context and reflect on what it said about his practice had greater importance than the content of individual responses.
The approach allowed him to collect feedback that provided valuable material to reflect on at his appraisal.