Title: Improving NHS Quality Using Internet Ratings and Experiences (INQUIRE)
Funder: Department of Health and Social Care

Abstract: AIM: To improve NHS capability to interpret online feedback from patients and the public, and to understand whether and how to act on this to improve services. RESEARCH QUESTIONS: 1. What is current knowledge on using online feedback on patients experiences and what do experts and stakeholders in the field (including patients and public) consider the most important related issues for the NHS? 2. Why and how do people choose whether to provide feedback, who are these people and what is the risk of biased conclusions? 3. How do NHS staff and organisations interpret social media and ratings sites amongst other indicators of patient experience ? What are the barriers and facilitators to using online feedback to improve NHS quality? What skills and capacity are required to draw benefit (eg immediacy, efficiency, transparency) and avoid harm (eg bias, confusion) BACKGROUND AND RATIONALE: As the NHS embraces a responsive, patient-centred, listening culture, it is important that it is listening, interpreting and responding to the right signals. As in many sectors, these ‘signals’ are increasingly coming from online content as patients use the internet to read and share their experiences of the NHS. We need to establish whether this online feedback is (or could be) credible and useful for NHS service improvement. RESEARCH ENVIRONMENT: The research is based in the Oxford University Health Experiences Research Group (HERG), part of the Oxford University Nuffield Department of Primary Care Health Sciences. RESEARCH PLAN: Five interlinked projects of applied health services research, each delivering NHS benefit and academic outputs in their own right, and adding value to each other. Project-1 What is known regarding online feedback from patients? A stakeholder/expert consultation and scoping literature review. Project-2 Population survey to identify the extent of the use of online feedback and public characteristics and attitudes towards it. Project-3 In-depth qualitative work to explore the motivations and actions of people who choose to create or use online feedback. Project-4 What are the attitudes and behaviours of frontline NHS staff to online feedback? Surveys and focus groups of health professionals to understand use of and attitudes to online feedback. Project-5 NHS case studies to capture the views of other staff groups (NHS managers, and other non-clinical workers) and understand organisational practices in relation to online feedback.

Lay abstract: People use the internet to access customer reviews and ratings of holidays and shopping purchases. Sharing personal experiences on Facebook or Twitter is becoming a familiar part of everyday life. Increasingly, people are going online to give feedback on their experience of the NHS, or to read the feedback that other people have provided. There are websites which invite feedback on doctors or hospitals, and some people choose to tell their NHS stories in personal blogs or discussion forums. In this research we are asking: How should the NHS interpret and act on patient experiences as online patient feedback to improve the quality of NHS services? Our team of researchers has expertise in studying the internet and health care, in studying patient experiences, and in studying NHS organisations. We have worked closely with the NHS to improve its services in the past, and the lead researcher has an extensive track record working with NHS digital services. In designing this project we have consulted widely with the NHS and worked collaboratively with patients and carers, and we will continue to do so throughout the proposed work. We will: Talk to experts in the field and examine previous research to find out about previous initiatives and current practice in this area, and to identify what lessons the NHS can learn. We will find out whether online feedback seems to be a good measure of the quality of healthcare. We will also try to predict future developments and challenges, so that the NHS is prepared for these. Study why people choose to comment on health services, and find out who are the people who read and write online feedback. This will help us to understand more about who this feedback comes from, how people expect their feedback to be used and what influence it has on other patients. This will help the NHS to interpret the feedback it receives. Study NHS staff and NHS hospitals and GP practices to find out how the NHS and its staff view online feedback, and what they do with it. This will help us to understand what the challenges might be in encouraging appropriate use of this feedback in the NHS. The findings of our work will have the potential to revolutionise the way that the NHS responds to patients, their carers and the public. We will help the NHS understand when and how to use online feedback, and we will provide the tools to use it to improve services. Ultimately this could lead to improved patient experience in the NHS, and a higher quality health service with better health outcomes.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE