How can I collect feedback when my patients are too young to respond?
This case will help if you:
- work in paediatrics or neonatology
- have patients who are infants, children or young people
- have patients who cannot give you feedback themselves.
Key points to consider
- It’s important to collect and reflect on patient feedback for revalidation, whatever your role or specialty. If you see a small number of patients, or patients who can’t give you feedback because of their age, you should still assume you have to collect patient feedback and consider how best you can do this.
- You should consider the specific needs of your patients and adapt the process so that you receive a good number of responses from a representative sample of patients you see.
- You can use a ‘proxy’ to respond on behalf of the patient if they are unable to respond. This could be the patient’s family or carer.
- If you think it may not be appropriate to ask a patient or their proxy for feedback because they are too distressed, you should use your professional judgement in such cases. You may need to consider when would be the most appropriate time to approach them for feedback.
- You should not collect feedback responses yourself, or ask your responsible officer or appraiser to do this.
Dr Jez is an Associate Specialist in neonatology working in an NHS hospital. She works in a low dependency unit supervising transitional neonatal care and provides neonatal support to the special care baby unit (SCBU).
Her role is focused on inpatient care with the occasional outpatient clinic. Because of the age of her patients, Dr Jez has to ask parents or carers for feedback.
Gathering enough feedback is challenging due to the low turnover of patients receiving inpatient care. On the postnatal ward Dr Jez sees approximately two to three patients per day, and on the SCBU approximately ten new patients per week. She finds it challenging to ask parents for feedback who have received upsetting news.
How the doctor met our requirements
Dr Jez used a tool developed by the RCPCH for use in intensive care unit settings called the Paediatric Carers of Feedback (PaedCCF) tool. It is a feedback form of 17 questions designed for use with parents and carers, but children and young people can complete the questionnaire if they’re able to.
Respondents are asked to give the doctor a rating of between 1 and 5 and there is also a space for free text comments. Doctors should collect 40 responses to make sure their results are sufficiently valid and reliable.
She asked two experienced nurses on the neonatal ward and SCBU to give out feedback forms to parents and carers on her behalf. She let the nurses know when she’d spoken to parents on the ward, or asked them to approach parents they saw her having discussions with in the SCBU.
She used her professional judgement to decide when and how soon to ask parents who had received upsetting news for feedback, and asked the nursing staff to approach the parents at an appropriate time.
She regularly reminded the nurses to hand out the forms to make sure she received enough responses. Asking for feedback on both the postnatal ward and the SCBU meant she was able to get enough responses covering her whole practice.
She arranged for completed questionnaires to be returned to the nurses’ station in a sealed envelope with her name on it.
This meant the she was not directly involved in the administration to ensure anonymity and confidentiality.
The questionnaires were sent to the royal college for collation so that a personalised report summarising the feedback and comparing it against a cohort of peers could be produced for the doctor.
Dr Jez was able to reflect on the quantitative and qualitative patient feedback, which gave a boost to her confidence about her patient interactions and reinforced existing good practice.