Patient Opinion International
This entry has been selected as a finalist in the
Disruptive Innovations in Health and Health Care: Solutions People Want competition.
Project Street Address
Project City
Project Province/State
Project Postal/Zip Code
Project Country
Focus of activity
Service/process
Year the initiative began (yyyy)
2005
Which of these barriers is the primary focus of your work?
Patients not empowered
Which of the principles is the primary focus of your work?
Center consumers in business model
If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:
This field has not been completed
Name Your Project
Patient Opinion International
Describe Your Idea
Define the innovation
The classic mechanisms for users to improve services are ‘exit’ and ‘voice’. Many healthcare systems use exit and competition to drive up services. Voice by contrast has often been limited to complaints and surveys. Whilst useful these are neither fine-grained nor timely enough to drive quality at the micro-level.
Patient Opinion adapts Web 2.0 technologies in a new platform that enables Voice, that is the voices of thousands of patients, to be heard at the scale and speed of the web.
The history of Web 2.0 to date shows that it is easy for citizens to use – just hit the send button. But hard for organisations like hospitals and managers to respond to - what can you do about the photo of the dirty toilet on Ward 19 that’s been on Flickr for 6 months?
If typical Web 2.0 success stories like MySpace are driven by ‘Me’, Patient Opinion seeks to be about ‘Us’ – a platform that many parties can join and where the aim is to long-term service improvement for the benefit of all.
All opinions stay on the site for 12 months and are followed by comments from other stakeholders but not the general public. This leads to conversations that are more structured and permanent than e-discussions and more inclusive and measured than blogs.
Such conversations clearly increase the power of the patient voice whilst allowing staff and managers to put their side.
Results to date show that:
• >50% of postings are appreciative.
• Hospitals do change services as a result of postings.
• Third party payers use the data to monitor contracts with hospitals
• Our subscription model is viable and makes sure we pay attention to working with hospitals rather than to the needs of advertisers.
We believe that platforms like Patient Opinion have great potential in many different health systems and we would love to hear form people who would like to collaborate – please email me at info@patientopinion.org.uk
As this proposal suggest we are particularly interested in developing an open source pool of collaborators who can spread the costs of further software development whilst creating a set of tools that can be adapted to many different health systems.
Context for Disruption:
Patients see more than staff know – and certainly more than they ever use in improving health services. So we built Patient Opinion to access the collective wisdom of patients using the same Web 2.0 tools as drive MySpace and blogs. Patients can share their stories and rate the care they receive down to ward and department level.
So far so good – but why is this disruptive? When we started we thought Patient Opinion would be about feedback and evaluation. After 18 months and thousands of postings we now understand that it is about conversations, democracy and improving services by making the patient voice more audible. RSS feeds mean that stories can be directed to just the right manager or doctor. And they can tell the world how they’ve improved things (See http://tinyurl.com/2uftmx ) Right now we’re just enabling national patient groups and MPs to add their comments to particular conversations.
Patient Opinion is a successful not-for-profit social enterprise that carries no advertising and raises income via subscriptions from hospitals and 3rd party payers who use the data to improve services. Patients are better informed and supported, services improve and staff feel supported.
We are now getting frequent requests from people in other countries who want to start something like Patient Opinion. So this bid to Ashoka is to help us begin the process of turning our software and code into an open source community that could be adopted anywhere in the world. This is how it would work: groups signing up to our key principles (social enterprise, primary responsibility to patients not other stakeholders) would get access to the Patient Opinion software which they adapt for their own health systems and in return add features to the open source common code pool. Patient Opinion UK would develop a mechanism for signing-off key improvements and would work to generate a community of world-wide patient feedback platforms.
Delivery Model
We will base any international delivery model on our experience here in Britain where some 50 million people in England are served by 400 hospitals each with hundreds of Wards and departments. Populating all these with stories and ratings takes a lot of work. Much of this is done via the web of course and we spend a lot of time on publicity and raising awareness of Patient Opinion nationally.
In addition we work with hospitals and family physicians in the communities that subscribe to Patient Opinion to generate postings locally. This work is paid for within our subscription model – local work is funded by local income and this in turn means that we can guarantee at least 1,000 postings per year per hospital. Such volumes are much more useful to everyone – a thousand postings about one hospital is more use than 1000 postings about 400 hospitals.
By choosing which family physicians to work with we can also ensure that poorer populations and those without internet access can feed in their comments via free phone calls to our staff and freepost questionnaires. This means that more than half of all our postings and feedback come from the poorer side of the towns that we work intensively in.
Currently some 30 hospitals or third party payers subscribe to Patient Opinion. This represents some 4 million people and around 5-8% of the total English market. If subscriptions accrue at the current rate we should reach financial sustainability early in financial 08/09.
Key Operational Partnerships
Patient Opinion has already been contacted by colleagues in 6 different countries. Our international work would be developed through mutual collaboration with these and other interested parties.
In the UK our partners include central Government England and Regional Strategic Health Authorities who have responsibility for populations of 6-15 million people and who oversee all health services in their areas.
Patient groups also welcome both the up-to-the-minute view from the front line that Patient Opinion brings them and the opportunity to join local debates. In turn their members are a key group who feed stories into the site.
We have recently partnered an European Union fund aimed at regenerating the local economy in Sheffield where we are based. Their $200,000 equity investment in Patient Opinion is to support the development of Patient Associates – a cadre of people with long-term conditions who are thoughtfully passionate about their local hospital who will work with local hospitals to improve services using stories from the site.
Financial Model
Most websites are driven by advertising. This is unsuitable for Patient Opinion because:
• Strong threshold effects (no one advertises at low volumes) mean that income does rises only when the site is successful
• Many advertisers on patient feedback sites include personal litigation lawyers and purveyors of therapeutic nostrums of unproven worth.
Patient Opinion therefore generates income via a subscription model. This has the advantage that
• income scales with costs in each participating health community
• Value can be extracted from large volumes of stories about a few hospitals much more easily than it can from large volumes of stories about many hospitals.
• As an organisation we pay attention to the needs of providers as well as the public.
• Having many distributed subscribers (currently more than 30 organisations) reduces our dependence on a few big funders and so protects our editorial freedom.
Patient Opinion incorporated as a Company Limited by Shares in January 05. Up to March 07 95% of our income came from government start-up contracts.
Having designed, piloted and further developed the software we have been trading since April 07 and this year 90% of our income will come from subscriptions by organisations.
This year we will also extend Patient Opinion to cover mental health services in England; and acute hospital services in Northern Ireland, Scotland and Wales all of which will create additional income streams.
We do not see our international work as generating income except in so far as an open source approach to software development reduces programking costs.
We have three classes of Share holders: A shares are owned by the 4 Directors. In addition we have 20+ B shareholders who we have recruited to hold us to account: we would need their consent for example if we were to convert Patient Opinion to a for-profit model.
Finally there are non-voting C Shares. These act as an investment vehicle – currently 10% of these have been sold to a local European Union economic regeneration fund for a value of £100,000.
What is your annual operating budget?
90%
What are your current sources of revenue? (please list any sources that are foundation grants)
Subscriptions: 90%
Contracts to extend or develop Patietn Opinion software within the UK 10%
Grants - zero
In addition we have personal loans worth £38,000 and investment from South Yorkshire Key Fund (EU) of £100.000
Effectiveness
Site statistics
Several thousand people have shared their story or rated a service on the site.
Currently we receive 350,000 page views per month
Around 50% of stories are appreciative and we forward these to staff whenever we can identify them regardless of whether their organisation subscribes or not.
25% of stories are critical and 25% are mixed.
Around 5% of stories currently generate a response.
Subscriber statistics
Some 30 health service organisations subscribe. These include hospitals, 3rd party state payers and groups of family physicians and regional Strategic Health Authorities.
Wider impact
In addition we share information with a range of patient groups like Diabetes UK and are just starting to work with Members of the UK Parliament (MPs).
We have made presentations to the Prime Minister’s Delivery Unit (a key government department) and led seminars on the implications of Web 2.0 for leading policy makers in the Department of Health.
Our aim is to generate >100,000 stories by 2009. To direct these to 3000+ managers and doctors by the same time so that each story goes to just the right manager. For every 1% of stories that generate an improvement in care Patient Opinion will then be creating 1,000 patient-led improvements.
Which element of the program proved itself most effective?
Since we started Patient Opinion 2 ½ years ago we have learnt the following key lessons about being effective:
• Patients are thoughtful and reflective about their health care – a great source of wisdom and service improvement
• Tapping this wisdom using Web 2.0 tools is practical, exciting and very worthwhile as it opens the possibility of creating improvements on an ‘industrial scale’ i.e. for Patient Opinion potentially to support many thousands of improvements across a given health system.
• A subscription based model works and is very suitable for social enterprises and other organisations without enough capital to sustain themselves till ‘web lift off’.
• Structured, public conversations on line can indeed drive up quality.
• The most difficult task is getting staff at hospitals and other organisations to understand the potential of sites like Patient Opinion – they are too often too busy doing other things.
• There is significant international interest in spreading Patient Opinion-like models to other countries. We would love to hear form any one who is interested in collaborating with us – email us at info@patientopinion.org.uk
Number of clients in the last year?
In 2006/07 we had 9 subscribers
in 2007/08 we have 30 subscribers.
What is the potential demand?
The are around 300 organisations runing hospitals in England plus 150 3rd party payers (Primary Care Trusts).
In addtion there are a further 10-15 hospitals and organisations in Northern Ireland, Scotland and Wales who we are either wroking with curently or are potential customers.
Finally we plan to extend Patient Opinion to mental health services this year ( a further 90 provider organisations across the UK) and to family practictioners and ambulatory care in 2008.
Scaling up Strategy
Our subscription model means that income scales with subscriptions. This frees us from the tyranny of the internet where pressure to secure advertising means that organisations live or die by the number of postings they can generate.
Subscriptions also mean that we can work with whole health communities both to generate a more balanced selection of stories and to help turn more stories into improved services.
The key challenges for growth are balancing the following:
• Driving up postings and site activity
• Managing cash flow
• Developing the internal capacity to deliver services.
All these remain on-going challenges and will be for any sister organisation round the world that wishes to build a similar site. Long-term plans to develop an open source model for software development and thus sharing costs therefore make a great deal of sense
Stage of the initiative:
1
Expansion plan:
Our current business plan defines seven key business objectives for the next three years:
• Drive use at the site to achieve in excess of 100,000 postings by 2009
• Learn from customers about what they want and continue to deliver it with the aim of securing subscriptions covering at least 40% of all Trusts, PCTs or other NHS organisations by 08/09; and deliver a year-on-year renewal rate by Trusts in excess of 80%
• Develop cost-effective ways to deliver patient centred editorial capacity via a strong and vibrant Patient Associate programme.
• Grow the financial and internal capacity within the organisation to support this level of rapid growth
• Learn how to generate more improvements in services from patients’ comments on the site through developing Patient-Led Appreciative Inquiries
• Develop the culture and imagination of the organisation in line with our core values so as to maximise the potential of both staff and the Patient Opinion platform.
• Explore possibilities of building an international family of patient feedback platforms (Patient Opinion International) with the aim of providing inter-country support and learning; and developing an open-source software development programme that serves all communities whilst being adaptable to all health systems
Origin of the Initiative
About 5 years ago I was sitting on eBay looking at the reputation scores of buyers and sellers. Just as these reputations essentially keep players on EBay honest I realised that patient-generated reputations could be just as powerful in terms of driving quality in health services.
This Entry is about (Issues)
What are your two main challenges to finance the growth of your initiative
Challenge One: managing cash flow and lack of working capital. As a not-for-profit it always feels as though you are running from one cash flow crisis to the next. Government policy in the UK recognises this porblem but has yet to really solve it.
Challenge Two: this lack of working capital makes it hard to manage rapid growth, or exapnd into new service areas, especially of course when this callls for up front investment.
On the other hand there is a clear 'social entrepreneur' premium. For us this means that hospitals and patients undoubtedly view us in a more positive light than they would a for-profit company; and the litigation risks that Pateint Opinion carry are reputedly reduced by our not-for-profit status. (Happily we have never had to test this hypothesis yet).
How did you hear about this contest and what is your main incentive to participate?
Conversation with Silvia Giovannoni of Ahsoka UK office following Skoll Conference in Oxford UK March 2007.
Do you have an annual financial statement?
Full financials available on request
Do you currently have an annual financial statement that tracks profit/loss?
My understanding is that international entrants are eligible for an award of $5,000. If we won we woudl use this to initiate international development with interested colleagues around the world.
Please describe the amount (and/or type) of funding you need to implement your initiative, at year 1 and at year 5.
This field has not been completed
 | malcolm rigler said: Your approach to promoting reflection and change within the NHS seems to me to be well worth developing. I actually had a "eureka" ... about this idea. - 871 days ago read more > |
| Paul Hodgkin said: Paul Hodgkin, CEO Patient Opinion and Family Physician You're right - getting/helping/persuading hospitals to respond and to improve ... about this idea. - 947 days ago read more > |
| Tyler Ahn said: Dear Dr. Hodgkin: Yet another question from us! Your feedback mechanism, unlike many other patient driven medical feedback websites ... about this idea. - 948 days ago read more > |
| Paul Hodgkin said: Thanks for the comments. You're right the initial entry costs for Patient Opinion in other countries could be very low. For us the ... about this idea. - 993 days ago read more > |
| Tyler Ahn said: Dear Dr. Hodgkin: The feedback loop that you have created for patients in the UK, we feel, have a very low barrier to implementation ... about this idea. - 997 days ago read more > |
| Donna Daniel said: Donna Daniel, EdD - I appreciate anything a hospital or large/corporate medical group do to truly give a voice to the individuals and ... about this idea. - 1006 days ago read more > |
Take action: |
||
|
share this entry |
add to favorites |
|
|
discuss |
||
Quick Translate:
This Entry is about:
Links:
- 426 reads