my_$publicservice.org

The actual success of Patient Opinion and the promising early signs shown by MyPolice prompt an obvious question for those of us involved with public services which are neither health nor police: can we have one too?

In both those areas, it is pretty clear that focusing on the concept of a complaint being at the centre of the process is pretty unhelpful.  The Independent Police Complaints Commission openly acknowledges the weaknesses of the system in this area.  As its chief executive, Jane Furniss, recognises:

If, last night, your front door was kicked down because police officers thought your house was actually a drug den, what you would probably want to know is ‘can my door be put back on its hinges, can I have an apology and can you reassure my children that this will not happen again on another evening’.

The same article (and no, this is not my normal reading, but grateful to Lauren Currie for the pointer) quotes John Feavyour, Cambridgeshire’s Deputy Chief Constable and ACPO national lead on complaints and misconduct:

All too often, people who complain about the police end up even more dissatisfied with the service they’ve received than at the start of the complaints procedure.

The picture for the health service is much the same:  complaining is not necessarily what people want to do and is often not what they feel they have succeeded in doing.  Patient Opinion cites a survey by the Patients Association in which of those using the NHS complaints system, 20% had found the process “pointless” and almost a further 30% had found it “totally pointless”. By contrast, about 13% had found it “useful” and a further 2% “very useful”.1

Complaints processes tend to be designed on the assumption that they are about redress.  But it’s not at all clear that that is what complainants are looking for (which is probably just as well, because it’s not what they tend to get).   The Patients Association survey asked what people saw as the purpose of the complaints process.

  • 78%:  to ensure that everyone learns from the mistake
  • 75%:  to ensure it never happens to anyone else
  • 51%:  to change clinical behaviour

but only

  • 7%:  to punish those who have made a mistake
  • 7%:  to get financial compensation

But there is also a vital question of what the organisation thinks the purpose of a complaints process is.  If it is a safety valve, a means of finding and correcting the most egregious failures or a means of channelling immediate anger and dissatisfaction into a swamp of unresponsiveness, then it can’t provide any broader value.  That’s where the Patient Opinion model starts to look really attractive.  It is deliberately and carefully constructed to elicit feedback, not just complaints.  More than half the stories it gets told are positive, even some of the most harrowing, and it therefore creates a picture which is as clear about what is valued as it is about what is seen as in need of improvement.

So, can the rest of us have one too?

Like many simple and direct questions, that one breaks down into a number of smaller ones:

  • Do they have to be  - or are they better – run by outsiders?
  • Do they work for any service, or does there need to be a positive emotional bond?
  • Do they work better than existing complaints systems?
  • Do we actually need one at all, or should we got to where the conversation is?

There is no obvious reason why service providers shouldn’t build in customer response as part of the service itself.  Amazon, for example, encourages feedback on purchases as a core part of the business process.  Patient Opinion is paralleled (for better or worse) by feedback mechanisms within NHS Choices.  But there are, on the face of it, some attractions to there being a neutral forum which avoids even the risk of a perception of defensiveness or filtering.

‘We love the NHS’ is a rallying cry which generates an immediate and visceral response from a lot of people.  There is a huge emotional engagement with the health service which, for a whole range of reasons, isn’t and can’t be completely reproduced elsewhere. ‘We love the DVLA’ or ‘We love our tax office’ somehow doesn’t have the same ring to it.  Interestingly, though, ‘we love the police’ – or at least, ‘we love our bobby’ – gets some of that same emotional value, which is part of what gives MyPolice the space in which to operate.  I am not immediately convinced that the energy and emotional commitment exists to create and sustain this approach across anything like the full range of public services, though it is certainly an interesting exercise to reflect on where it might work – schools would be one obvious area, but I am not sure how many others there would be.

Looking for ways to extend the model presupposes that this is a better approach than purely internal processes.  It’s not entirely obvious how you tell,  but on the face of it, there are two relevant tests.  The first is whether the person giving the feedback is more likely to feel that they have been able to say what they want and to be listened to.  The second, and probably harder to pin down, is whether it is more effective in supporting service improvement.  Intuitively (which of course means I don’t have and haven’t looked for evidence), I would expect an independent organisation to be better able to do the first.  It might also be better at the second -  but there must be a risk that it is more easily ignored.

But maybe all this is just a laborious way of answering the wrong question.  People don’t necessarily need to go anywhere to complain or to praise – they can stay exactly where they are and make it one element of the conversation they are having anyway.  Twitter is just one place where irritation or approbation can be expressed about pretty much anything, Mumsnet is now a place where the Prime Minister is held to account and sites such as Fix My Street exist to capture and transmit more specific local concerns – and it is interesting that one of the latest Rewired State projects is Fix My Hospital, designed to complement Patient Opinion by capturing a rather different category of feedback.

For the time being at least, I don’t think that does quite add up to being a substitute for more structured feedback routes.  A few more Patient Opinion clones would be valuable, best if delivered by people with a passion for making them work, but no shame if not every service can attract that passion – and no necessary reason why each such service needs to be limited to just one area.

What really matters in the end is that we listen, and having listened respond and improve.

  1. It is important to note both that fieldwork for the survey was in August 2008 and that the numbers involved seem to have been very small (the full report is available here, on a quick reading it seems there were 484 responses, 309 wanted to complain, 174 actually complained).

4 comments

  1. I’m not sure where you’re going with this one. Is it about complaining? Is it about giving feedback? Or is it about sharing experiences?

    From my point of view, I like Patient Opinion because it’s full of first person stories sharing experiences. Some are complaints, and a lot are about good things. And they’re not addressed to anybody in particular, they’re shared with whoever’s interested.

    One of the things I like about sites like this is that they have the potential to be useful qualitative datasets for designers. They also have the potential to capture ideas and foster discussion; you could think of this as participative design, you could laso use it to help you prioritise projects. But there doesn’t have to be a project. People talked about hospital gowns were for years before there was a project to design a better one.

    I’d be very concerned if a site was marketed or perceived as “where you go to make a complaint.” People do need to feel they have permission to complain, but for me at any rate, it’s much more important to have a place where you can talk about public services, and you have confidence that the talk is going to get listened to.

    • Fair point: this post started out being about something slightly different, and in the rewriting has ended up with more of the language of complaints than it should have done. I agree that Patient Opinion is interesting because it is about stories rather than about complaints – and I did make the point that most of what appears there is positive rather than negative.

      But in the end, I think the last sentence of your comment and the last sentence of the post are saying the same thing: there needs to be a space where experiences are shared, and those experiences need to be listened by people who have the responsibility to act on them.

  2. Thanks for (yet another!) really helpful post on a set of issues we spend a lot of time thinking about. (Full disclosure: I am one of the Patient Opinion team.) There’s a lot to discuss here, but I’ll restrict myself to just two thoughts.
    1: We would make a strong distinction between feedback and complaint. It is a distinction that seems to be hard for the NHS, and perhaps other public services, to appreciate. The nature of the distinction is worthy of a proper discussion, but my feeling is that the desired end of feedback is improvement, whereas the desired end of complaint is reparation or redress. Often, we find that a patient may want simply to offer negative feedback, but the NHS wants to channel the patient into a “complaints process”.
    Both feedback and complaint are important. The lack of either will lead to loss of trust, while presence of both may enable the restoration of trust. To date, Patient Opinion has been focused on feedback, not complaint – but that may change. We do have some early ideas around supporting the possibility of “restorative redress” for health care on the web, but they are early.
    2: I’m struck by the argument about the emotional engagement in the NHS, and that this may transfer to some, but not many, other public services. This may be true, but I think we need to push the analysis further to find out why. The NHS often seems to be a service people love in theory but find frustrating in reality. It embodies values many would support. People feed back (we think) because they want the reality to live up to the values.
    So why couldn’t this be true of the Pensions Agency, for example? There are values here many could support. There is probably much activity many would admire. Is it just less tangible, less known, less dramatic? Could public feedback on the web actually be part of reconnecting such public services with the values they aim to embody?

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