VIEWPOINT: What counts as online patient feedback, and for whom?

Online patient feedback is quickly becoming pervasive enough to warrant serious attention. For many decades, patients have been asked and encouraged to fill out paper-based questionnaires to give feedback on the care that they received. These have been used for a number of reasons, including to measure how the service has been rated by the patients, and to suggest areas for improvement. They were seen as a good alternative to face-to-face feedback because their impersonal nature can allow patients to more comfortably give feedback about the staff who care for them whilst minimising social desirability effects. As well as this, the usual power dynamics between health professionals and patients were thought to be diminished, and patients could, in theory at least, offer honest critique without fearing pushback, or negative consequences on their subsequent care. More recently, with the advent of digital technologies and an increasing connectivity to the web, online patient feedback has been flung into the spotlight, stimulating research into how this might change current practice and whether it can lead to an increase in quality of care. In theory, patients can now leave feedback using a website or app at a time and place of their choosing, with or without anonymity, rather than doing so in person at the hospital or local general practice. Consequently, within healthcare organisations, the jobs of patient experience leads, quality outcome and assurance managers, and data analysts, amongst others, are changing to assimilate feedback gathered online alongside more traditional methods, and with this there are new things to learn about how best to harness and use this online patient feedback to improve quality and outcomes for patients. There is, however, a fundamental gap in the understanding of what constitutes online patient feedback. Generally it is referred to in monolithic terms, abbreviated to OPF in some sources, implying a universally acknowledged and understood phrase. However, as this field advances in research and practice, we need to deconstruct this, and consider more carefully what counts as its three facets: ‘online’, ‘patient’ and ‘feedback’. When describing online patient feedback there are often a number of different assumptions at play (see Table 1 below). These different assumptions exist not only between researchers, the public, clinicians, and staff in the NHS, but also amongst these different groups and which assumptions are held matters beyond just semantics. It could potentially affect many aspects of service delivery: who is able to give feedback (the patient? Their relative? An observer?); what content counts as legitimate feedback, and what gains attention from the healthcare provider (formal complaints? Recommendations for action? All comments?); and how health services may unwittingly shape the system in favour of certain people or certain types of feedback (are certain channels permitted or excluded? Are particular resources and skills required to access and use the channel?). We need to be much clearer in articulating what exactly we mean by online patient feedback. Early observations from an ethnographic study at various organisational sites in the UK (NHS Trusts) conducted by the author (FD) as part of a larger programme of work in this area, suggest that from an institutional perspective, there is a difference between feedback that is sanctioned (feedback obtained through a medium that is approved by the Trust as an official feedback channel), solicited (consistently asked for from patients or carers) and sought (actively searched for and used), and feedback that is unsanctioned (not officially approved), unsolicited (not asked for), and unsought (not searched for). We refer to these as SSS feedback and UUU feedback, respectively. SSS feedback is that which is actively solicited by organisations, teams, services and localities. Here patients may be encouraged to give feedback through a designated weblink, or asked to leave feedback