This is discussion about Patient Opinion International.
Donna Daniel, EdD - I appreciate anything a hospital or large/corporate medical group do to truly give a voice to the individuals and families it serves or treats. I would like to see this kind of 'feel good' tech given a place in most medical treatment facilities, so that feedback is gathered and - hopefully- given administrative and staff attention, such as the old 'suggestion box' was designed to do.
I'm not sure I can support the funding for this being gathered from an outside source, however, when the means for any new medical facility to obtain it is fiscally available in their profits. Let stake-/shareholders cry out for this, then it will be paid for, then let this funding go to projects that will not be so readily accepted, although it is certainly a great idea, whose time came decades ago but was often ignored in the rush to expand and develop. I wish you great success in this innovative project, and your patients no doubt have benefitted greatly!
Dear Dr. Hodgkin:
The feedback loop that you have created for patients in the UK, we feel, have a very low barrier to implementation in most other countries, especially anglophone countries. You indicate in your entry form that the funds from the award will go towards your expansion outside the UK. We would love to hear more about your expansion plans. (perhaps to the U.S.?)
Thank you in advance for your response.
Thanks for the comments.
You're right the initial entry costs for Patient Opinion in other countries could be very low. For us the most significant initial barrer was indeed the costs of software development so if we can get the kind of mutually supportive, open source model that we are proposing in this competition competition working, we feel that there would be some great benefits all round: a growing family of international and mutually supportive, value-driven sites; all contributing to a pool of ever-improving software.
That said we have found - that at least in the UK context - the technical platform is only the beginning: you need a business model that supports the costs of moderation and even more importantly is coherent with the patient-centered values of the business. We also work surprisingly hard at generating postings - from experience here in England the motivation for posting about health (which is typically anxiety or anger-driven) is very different from the desire-driven archetypal use of the web or the ego-driven postings on YouTube or MySpace.
And it is not axiomatic that hospitals will act on feedback to improve services even for highly critical postings.
So if we won the competition how would we use the $10,000? We would identify people in a range of countries who wanted to start a platform similar to Patient Opinion (we know of 5 already but if there is any one out there who wants to join in, just post a comment here).
We would then develop with them the basic ground rules for an open source development model. This would include getting clarity about the values and business model of any member system; how software developments were to be shared; and how progressive version agreement for core software was decided.
The basic deal would be that Patient Opinion would release its core software (written in ASP.net) to approved social enterprise partner organisations in other countries. In return we would expect partners to contribute programming improvements on an open source basis; agree to abide by versioning and development procedures for the software; and to share all the 'softer' aspects of their development and learning (since these are actually what turns Patient Opinion from another snappy web platform into an on-line, scalable way to develop democratising, self improving conversations that really can disrupt exisiting ways of doing health care).
So we really are interested in hearing from anyone, anywhere who is in position to begin such a process in their own country - just add your comment below.
So far as the US goes we would love to see Patient Opinion happening in the US but we have not proposed this as part of our submission as we feel we would definitely need a partner organisation who understood the complex and very special nature of US health care. The risk of being sued in the US has also made us pause - I see that a Texan hospital has just successfully won a court order forcing a US internet provider to release names and details of a blogger who has allegedly defamed it ( http://tinyurl.com/2s2gj7). But if there is a potential US partner out there then please do get in touch - we'd love to help make something happen.
Of course the whole point of our proposed open source model is to promote mutual learning about how to overcome these difficulties. Citizen-donated data about health at this scale is a new class of data and no one knows how best to use it (and that includes governments, hospitals, patient groups and Web 2.0 gurus). It is really important that value-driven civil society occupies this space as its quite possible to imagine unethical sites, funded by a variety of problematic advertising and based in lax legal jurisdictions, providing sites that are postively toxic to health care improvements and to staff.
We know that we at Patient Opinion are still a long way from having all the answers. What we want is a to help create a family of supportive organisations around the world who together can learn how to ensure that the disruptive and scalable power of web-based patient feedback really does improve health care.
Paul Hodgkin, CEO Patient Opinion and Family Physician
Yet another question from us! Your feedback mechanism, unlike many other patient driven medical feedback websites that we've seen, appears to have the incentives established for the medical industry to actually respond. You mention this very briefly in your entry. Could you expand on how the mechanism works and how the hospitals or doctors respond to the bad or good feedback that they receive?
Thank you in advance for your response!
Paul Hodgkin, CEO Patient Opinion and Family Physician
You're right - getting/helping/persuading hospitals to respond and to improve services is crucial. We're getting their but have not solved the whole problem yet. Things that we know help to encourage hospitals to improve include:
a. making the site easy to use: RSS feeds take comments to just the right person. We provide help translating bureaucratic responses into the conversational tone needed for the web.
b. stressing how the system can save money/reduce pressure on busy staff: the site can reduce complaints and - perhaps - litigation. (If we can show this then clearly it would be self funding from a hospital perspective)
c. involving other stakeholders increases pressure to respond. So we set up RSS feeds to local government departments, third party payers, local Members of Parliament etc. The fact that they can join the conversation and that their comments stay public, linked to specific services and departments, encourages hospitals to respond.
d. We are just beginning to develop patient-led initiatives: groups of patients with our support call a meeting of managers, clinicians and third party payers to discuss particular problems identified on the site. Since patients are always being told to be healthier we are experimenting with holding these in gyms (come and swim with us first!). The meetings are led ad run by patients and Patient Opinion and aim to a. disrupt the traditional relationships between these players and b. be unrelentingly positive (we, the patients, want you to be better so how we help? what are your strengths). The underlying method is Appreciative Inquiry. At the end of the meeting we post up conclusions on the site, linked to the service in question so that outcomes and agreements are immediately visible. We try and set time scale that reflect human time rather than health service planners time - i.e. doing something in weeks rather than months or years.
Overall the lesson is that there is no single magic bullet - a lesson learnt over and over again in studies that aim to improve health services. However it is also clear that the structured, public, transparent conversations that are held on the web for a year and publicly linked to a named ward or service do have considerable bite.
What’s more doctors and other staff whilst apprehensive at times appreciate that a. web feedback in one form or another is coming and b. doing it this way is helpful and constructive
Your approach to promoting reflection and change within the NHS seems to me to be well worth developing. I actually had a "eureka" moment when I learnt about what you are upto. Have you tried to share the concept and the success of this approach to NHS managers through say the Health Services Journal?