November 14, 2007

Why Patient Opinion is not another blog

Occasionally people say that Patient Opinion ‘is just another blog’. Which has made us to think whether we are and if not why not.
Blogs of course are a way to get your opinion out into the public domain which is of course part of what Patient Opinion does. With the added value that we aggregated lots of similar conversations into one place and tag them according to hospital service or disease for handy use.
But James (Munro who is a very major part of the wizardry behind Patient Opinion) points out that what we do is more subtle and useful than just providing people with a blog-like voice.

Because we give data feeds to a wide variety of other organisations (patient groups, MPs, Overview Committees to name a few) what we are actually creating are multiple conduits where a single blog comment can get mainlined into the ears of key stakeholders.
Of course all these people could just set up RSS feeds to do this for themselves. But it turns out – like so much on the web – that even if you give the core product away for free as we do by publishing opinions so anyone can see them, there is still a living to be made selling add-ons that make life easier for these stakeholder organisations.
An ordinary blogger publishes and hopes that someone will listen (i.e. their blog gets linked to and lots of traffic). By contrast Patient Opinion provides newbie bloggers (who mostly never want to make another comment again) with a ready made audience consisting of just the right clutch of local and national organisations who, on occasion, will really value what they are saying and even turn it into better local services.

Some useful similar thoughts came from William Heath’s excellent Ideal Government blog where William recently discussed ‘Customer Relations Management’ – which is the software and techniques developed to help companies manage us customers better in the hope that happier customers will buy more of their stuff.
William asks what it would be like if we citizens had VRM – Vendor Relationship Management. This would be a set of tools and information to turn our relationship with ‘them’ on its head and help us manage our relationships with public services in a more sophisticated and efficient way. What would a set of VRM tools look like? How could we enable citizens to get heavy handed bureaucracies and unresponsive commercial outfits to respond with speed and effectiveness?
I’m not quite sure but I think that something like Patient Opinion’s ‘blog-linked to just the right 5 key stakeholders’ would be part of the toolkit.

Posted by Paul at 8:42 PM

August 29, 2007

Why people won't post stories about their piles?

Posting stories to social health sites seems to be different to other types of site. And it’s not just that sharing the story of your haemorrhoid operation is qualitatively different to posting your holiday snaps of the Maldives to Flickr.
Getting the balance between personal payoff and social benefit seems to be genuinely tougher for health-focused social sites. And I’m not sure we’ve got it right yet on Patient Opinion. People post on the site out of range of motivations that include altruism, anger and gratitude – so there is clearly some personal and emotional pay off, and the telling of the story itself helps.
But we haven’t yet hit the big time – we may have had thousands of people posting stories and rating services but we’re still a long way from where we want to be.
Interestingly we’re not alone – the feedback section of NHS Choices is currently only receiving 2 to 3 postings per day about the whole of the NHS in England. And commercial sites like Organized Wisdom fair little better. This US site aims to help people who have experienced illness and disability share and organise their wisdom through structured ‘wisdom cards’ that say what was good and bad about a particular illness experience. A great idea but in the few months since they’ve launched they seem to have only manage to create 403 wisdom cards (unless I’m misreading the site).
So what would be the real motivator that would make people post about their illness experience? The sites with the most hits seem to be unmoderated and to mainly just offer a way to rate and comment about individual professionals by name. This produces both good and bad comments but in my view (and here I’m influenced by my own experience as a family physician) the motivation to both praise and libel your own personal doctor is often driven by fairly deep needs – we all tend to see our doctor as a bulwark against death. Or to resent the actual or perceived power that we have surrendered to them and hence to tell atrocity stories about them. (I know this isn’t always true but I do think it happens a lot).
So pure personal feedback is I think a lot less informative than people think its gong to be. Which is not to say that there won’t be quite a few successful sites that thrive by giving people the chance to publicly sound off about their doctor – there will be? But unlocking the social value that lies above these bottom feeder sites is the key to creating a site that actually helps people live with the enduring distress of illness and disease. And no one has yet found the personal pay-off key that will unlock even a fraction of the millions of health interactions that happen each week in the UK.

Posted by Paul at 8:30 PM

May 6, 2007

Whose data is it anyway?

Trying to improve public services has never been easy – get the boulder to the top of the hill and damn me if it isn’t half way down again as fast as you can say ‘Tony Blair’. And to make matters worse public services remain largely immune to Web 2.0 and all that it offers in terms of peer-to-peer commentaries and real-time reputation building. Like a dowager duchess the NHS sails on serenely, ordering a survey here and a focus group there to find out what ‘they’ are thinking, and never reflecting on when the creative destruction of Web 2.0 might manifest itself in the quiet back water of health care.
In part this is because citizen-donated feedback on the scale that the web makes possible is an entirely new form of data and no one really knows what to do with it. Who is best placed to generate it? How should it be fed back? How should managers respond? Is it useful? In short Whose Data Is It Anyway?
So it’s great that the Cabinet Office has asked Tom Steinberg to review how the state can best use all this new citizen-donated data.Over the 2 years that we’ve been piloting, testing and running Patient Opinion we have learnt some answers to these questions and over the next few weeks we will be sharing these with you here on the blog.
Interlacing user feedback with managerial responses at scale is new. The classic ways to ‘consult’ – surveys, focus groups, user reps etc - have evolved because they are easy for hospitals and service providers to run. But by the same token they are hard for the public to use. Which is why you don’t hear many patients asking for more surveys, please!
Conversely posting to YouTube. Flicker and blogging is easy for the public but hard for hospitals to respond to. As a manager what, exactly, am I supposed to do when someone posts a picture of a dirty toilet on a ward that I am responsible for to Flickr? Make sure it is now clean obviously (though chances are that this will have already happened). But what then? Leave well alone? Post a comment? Post a picture of the clean toilet? Get on with something more concrete? (for more on this see our recent article in Society Guardian)
So between surveys by providers that are all about ‘You and Them’ and the ego-driven world of You Tube and blogs that tend to be all about ‘Me and Mine’ there is little dialogue. Clearly what we need are new platforms that are driven by ‘Us’, that convert the collective wisdom of the many to appropriately improved services. And that prevent the apparently inexorably slide into toxic ranting that purely citizen-driven sites like You Tube are prone to.
This is where I think Patient Opinion comes is – a platform that can take comments at scale, direct it to just the right manager, and foster useful conversations about what needs to be done. We don’t try and replace the freedom of YouTube but we do try and make the offerings from patients easier for managers and staff to hear and to respond to. So that hopefully we all get better services (link to posting with Trust response on it).
Of course we are not the only ones doing this kind of thing. Dipex has been running a condition-specific service a bit like this for years. And from this summer we’ll have NHS Choices – the new NHS wunder site that is meant to be all things to all patients.
What’s important about all this is recognising that this new class of citizen-donated data demands new responses and new infrastructure. If we are going to survive the 21st century then web-mediated tools that collectivise the wisdom of the many and turn it into appropriate action will be absolutely essential. Creating these tools so that they reflect civil society as well as the commercial imperatives of current individual-centred platforms like You Tube won’t happen by accident. The toxic slide to clips of teachers with pornographic voice-overs that has already happened on Youtube will probably soon be replicated for nurses and health workers. But that does not have to be the end of the story. Create the right platform and conversations become easier not harder. Get the right people involved and services improve as a direct result of patients’ insights.

Posted by Paul at 8:03 AM | Comments (0) | TrackBack

May 4, 2007

Making sure we have a choice about voice

NHS Choices, the new DH-owned, Dr Foster-led wunder website for the NHS is due to go live this summer. Reportedly costing between £8 -15 million we are looking forward to its launch and hope that it will provide a great new resource for patients.
Amongst other offerings NHS Choices will contain a ‘Voice’ section where patients can share the story of their care at English hospitals and rank the service they have received using Amazon-type ratings. Which looks remarkably like what we do at Patient Opinion – so if imitation is the sincerest form of flattery then we’re certainly flattered!
The great unknown is whether such feedback systems are best owned and run by government, a not-for-profit social enterprise like Patient Opinion, or a for-profit private commercial business. Given that all the data generated via NHS Choices (including email address and postcode) will be owned by the state we believe that people may be wary of a government owned platform. And since the most plausible buyers of Adwords on such a site are ambulance-chasing lawyers and purveyors of therapeutic snake oil, the usual advertising-driven business model may be problematic for feedback platforms about health.
Which is why we built Patient Opinion as a not-for-profit subscription-based business in the first place. Having a viable business model based on a distributed income stream derived 30+ organisations guarantees our financial independence. We can moderate and publish postings without spin and have us a market incentive to make sure that patient feedback is actually valued by Strategic Health Authorities, Scrutiny Committees, national patient groups and other subscribers.
But maybe we’re wrong. Maybe Joe Public won’t care that the state will own his or her data and ID details. So it’s great that people will have a choice of feedback platform. We believe that they are more than capable of using each platform to get what they want. If they actually want tell the Secretary of State something or have a hot-line to the Chief Executive of the relevant Trust then they should use NHS Choices. If they value independence, a platform dedicated to patients and a service that strives to to turn their feedback into better services then they may be more inclined to log into Patient Opinion. And if they just want to share their comments locally they may be happy with either.
What’s more important than anything is that we have the debate and work out how best to use this new class of data – large volumes of web-mediated citizen feedback – for the good of civil society as well as state or commercial interests. So over the next few weeks we’ll be posting lots about these issues to the blog and will be really interested in your comments and thoughts.

Posted by Paul at 9:13 AM

January 13, 2007

Has any body done anything like Patient Opinion before?

Nope! Dont think so. And we did not hear of anything like us when we led a seminar for the Prime Minister's Delivery Unit last year. But there are quite a lot of American sites that look as though they do the same. For example Revolution Health and RateMD.com both look good and allow you to rate your own personal doctor. But on scratching deeper I could only find positive ratings. Perhaps not surprising given that:
a. both sites are driven by advertising
b. the litiginous nature of US medical practice.

They are surely ambitious though. Revolution Health was founded by Steve Case the ex Chief Executive of AOL who in a related blog is reported as saying he wants the site to be the site where US health consumers can go for everything - comparative outcomes data, health advice about every condition and procedure, and how to compare different health insurance packages. Hard to tell if it will work since the site is still under beta-testing.

We have always thought that the business model underlying our kind of site was really important. There are just so many competing interests (and of course we have our share too) that its all too easy for the needs of the business to drive and distort the site content. After a lot of thought we came to the conlcusion that if there was a sweet spot that managed these conflicts to everyone's advantage and that promoted transparency, it was as a social enterprise driven by subscriptions from organisations about whom the comments are made.
At first glance this looks just as conflicted as any other model. But by giving RSS feeds to other organisations (local commissioners, Scrutiny Committees, national patient groups etc) the voice of the patient on the site is leveraged into something that providers just can't ignore. If there are comments about an opinion from your local commissioners, a patient group and the MP, then suddenly subscribing begins to make sense.

Posted by Paul at 4:02 PM | Comments (0)

January 2, 2007

All mixed up about mixed sex wards

News from the Cutting Edge
"When I was having breast surgery I had 2 nights in a general surgical ward which had male and female patients. I didn't like it especially when the health care assistant left the door open when I was on the comode and a male patient walked past. I can see no benefits of mixed sex wards for the patient."
Unsurprisingly women don’t have a good word to say about mixed sex wards – which contrasts with men who rarely comment to us about this. And as the publicity about mixed sex wards intensifies there is the distinct sound of pigeons coming home to roost. Not only is the NHS having to deal with the fact that almost no one likes mixed wards, it is also having to correct a longstanding fudge about what ‘single sex wards’ actually mean.
Of course for patients a singe sex ward is just that – a ward where you won’t meet a patient of the opposite sex. But for managers single sex wards have usually meant single sex bays which allowed the stock of beds to be used at higher capacity.
When waiting lists were long, and MRSA rates low, the occasional embarrassment of singe sex bays was acceptable if it meant faster treatment (even though the trade off was rarely made explicit).
But now we know that MRSA rates rise sharply as bed occupancy exceed 85% and, as waiting lists fall, such slight of hand is increasingly unacceptable.
And sometimes the down right appalling happens as when Janet Street-Porter’s dying sister woke up to find a naked man masturbating beside her bed.

Things don’t have to get this bad for us to do something. Patient Opinion is currently emailing people who have posted opinions following an In Patients admission to find out what their experience of mixed sex wards and mixed sex bays was like. When the results are in we will post them up on the site and here on the blog. But in the mean time if you have any experiences about mixed sex wards you want to share then post them up as stories or email us.

Posted by Paul at 4:35 PM | Comments (0)

December 17, 2006

News from the Cutting Edge

Catalytic social innovations can change the world.

Having arrived at A&E ...waited for nearly 11 minutes before anyone arrived at the reception desk.This was at approx 6 O'Clock in the morning on a Saturday.The whole place looked deserted and like the aftermath of a football match with litter every where in the waiting area. The room that we were put in ...still had traces of blood on the floor and the bed frame.the ladies toilets were filthy with soiled paper blood etc...The nurse that came to check blood pressure etc. was very off hand and abrupt...

“Why should we pay you to provide a website where patients can just slag us off in public?” Director of Nursing, Acute Hospital

An understandable reaction perhaps given the nature of comments like the one above. But the real point here is the potential learning that such feedback creates for the organisation - not to mention future patients and commissioners.
Some change is incremental and can be accommodated easily with existing business practices. Other innovations are disruptive and make players uncomfortable.
Patient Opinion – and many other web 2.0 businesses – clearly has the potential to be disruptive. Managing this and ensuring that the overall impact is positive for society, patients and the NHS, whilst surviving as a business makes for an exciting ride.
Which makes an article in this months Harvard Business review by Clayton Christensen (who wrote the definitive book about Disruptive Innovations)particularly relevant. This time he is not talking about the effects of disruptive innovation in business but the ability of to generate better ways of solving social problems through social enterprises. What is it about The Big Issue, or micro-lending, or the Fair trade movement that makes them capable of changing society where welfare state interventions fail and businesses see no commercial opportunity?
Classically there have been two kinds of innovation: sustaining innovations (a better way to make widgets) and disruptive innovations (something that makes widgets obsolete). To this he adds catalytic innovations – innovations that put widgets to completely new uses in order to meet a social need.
Catalytic Innovations have five qualities:
• They create systemic social change through scaling and replication. This means they are not just one-off projects but that the mechanisms and resources to solve very large-scale problems are hard wired into them.
• They meet a need that is over served (because the service offered is more complex than people want) or not served at all.
• They typically offer ‘good enough’ services that are often of lower quality but which are more accessible and replicable.
• They generate resources in ways that are unavailable or unattractive to incumbents
• They are ignored or disparaged by existing players who find the new business model unprofitable or unattractive.
Interestingly Patient Opinion fits all these criteria. Our web-based structure meant that we always knew that we could scale. Indeed it is hard to think of any reasons why we would not want to be a national platform. And our subscription model creates the resources to support rapid growth.
Current systems for involving the public are both more complex and less effective than a web based system like Patient Opinion. Traditional ways of measuring feedback have their uses but speed, cheapness and universal cover are not amongst them.
By the same token Patient opinion offers data that is less ‘objective’ than surveys but which is never the less perceived as being ‘good enough’. Indeed in terms of demonstrating measurable service improvements quickly it out scores representative surveys every time.
The business model is also unattractive to incumbents: for-profits like Dr Foster find the risks of being sued unpalatable. And they are understandably uneasy about a product that sets out to make their core customers uncomfortable. It is hard for example to imagine a for-profit company publishing this kind of comment about one of its customers.
"...my father was treated appallingly in a local hospital last year ...he was left in a filthy ward, sitting in a plastic chair day and night for a month, suffered horrendous bed sores....not given adequate pain relief, not given clean drinking water,on one occasion he was left overnight in soiled pyjamas..."

All very comforting to know but does it help the business? Well yes. The article made it clearer to me that in many ways what we are selling to hospitals is a new and catalytic way of interacting with patients. As a provider you can choose not to reply to critical comments liek the ones above. Or you can see them as a learning opportunity. Our job at Patient Opinion is not to sell feedback but a service that enables hospitals to create fast, public, visible, measurable improvements in all those micro-aspects of service that are really important to patients.
Catalytic social innovations are important because they harness new opportunities and income streams that are largely invisible or unattractive to commercial or public sector incumbents and from them create new scalable solutions to social needs. It’s good to know that Patient Opinion fits the criteria exactly.

Posted by Paul at 12:56 PM | Comments (0)

December 8, 2006

News from the Cutting Edge

Being hip on the web ain't easy for organisations
It just isn't easy for big NHS organisations that - let's face it - have been used to handling feedback on their own terms, to 'get' how to respond on the web.
This posting is pretty critical of the Hallamshire Hospital:
".. my care was very poor. The communication was very poor from many of the nurses who looked after me. I was very anxious and the poor communication made this worse.... The post operative nursing care that I recieved was virtually non-existant.I lost over 8lbs in weight, through being nil by mouth for 20hrs, and having little appetite for 4 days post operation.
So even though they do not subscribe to Patient Opinion, we offered the Trust a chance to respond and this is what they said:
"Sheffield Teaching Hospitals Foundation Trust take any concerns expressed by patients very seriously and would like to apologise for the poor experience described in this case. The Lead Nurse and Matron responsible for ward I2 are implementing a number of actions in response to the concerns raised."
This kind of response is the norm for Trusts when they first start responding on Patient Opinion - whilst the motive and the actions are sincere (I'm sure that the Trusts really is trying to improve services on the ward) the tone of the posting fails to do justice to their efforts and may not give the person who posted it, or any member of the public reading it, much confidence that anything is going to improve. It is just so easy for this organisational bureaucrat-ease not to mean anything much outside the NHS laager.
I guess what is needed is for organisations to relax a bit. Hard I know in such a litiginous age. Rather than just slouching around and being negative we tried to put together an alternative response.
"Thanks for taking the time to post on Patient Opinion. It sounds like you had a really tough stay and that at times we didn't help much! I've taken your comments to the ward meeting - what you say about patients loosing weight really struck a chord with the staff as we all know how important good nutrition is to getting better. And of course they also know just how easy it can be not to want to eat properly when you're feeling poorly. As a result they decided to ...."
Any better? Any legal reasons why a Trust couldnt respond like this?

Posted by Paul at 5:34 PM | Comments (0)

December 6, 2006

News from the Cutting Edge

Get those toilet seats right
This story is one of my favourites - a pithy paragraph about great care. And the trials and tribulations of men having to use hospital commodes that are designed for women when they are recovering from hip replacements. Which is not one of those things that features in your average patient feedback but which, when you think about it, is really important.

And although its not on the site the back story is that the staff on the ward read the comment and designed a 'top commode' parade as a result and asked the next cohort of men with hip replacements which one suited them best. And then bought that one for them! Which is fantastic - and just what the NHS (and Patient Opinion) should be able to do.
Interestingly this is just what Trevor Gay is talking about on his Simplicity blog today.

Posted by Paul at 9:42 AM | Comments (0)