23 March 2010
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
- 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.