A clinician’s perspective on patient feedback and improvement


In August 2018 I began my secondment with the Yorkshire Improvement Academy as a Clinical Leadership Fellow. One of my projects was improving patient experience and involved collecting patient feedback for staff to use for improvement purposes. Before I started, researchers, clinical staff and volunteers had already worked together to develop an evidence-based intervention, called the Yorkshire Patient Experience Toolkit (PET). The toolkit was tried and tested across 3 different NHS organisations. It involved identifying a clinical team wishing to improve patient experience, working with volunteers to collect up-to-date feedback from their patients/carers, and supporting them with PDSA improvement cycles to make changes based on this. My secondment started at the time of implementation and I was involved in supporting frontline teams to start using the approach.

I was handed a copy of the PET which looked very impressive and user friendly. Despite this, I had some reservations about PET, the implications of making patients the focus and, therefore, how it would be received by frontline teams.

In this blog I will share personal insights and the learning I have gained as a clinician involved in improving patient experience.

Improvement is in our DNA – don’t we do it anyway?

Having worked as a physiotherapist for 13 years, my insights and experiences of the NHS have shown that improvement is something we all strive to do. Yet, given our busy working lives and competing agendas it is often difficult to make lasting systemic changes. Constraints in time and resources may contribute to staff feeling overwhelmed, frustrated and disempowered. Personally, this has resulted in attempts to implement solo improvement projects which have required high energy and emotional investment, in which, a failure to sufficiently engage colleagues led to personal despondency and exhaustion. My concern in both cases is for the health and wellbeing of staff who want to be understood, given the opportunity to be heard, to bring about sustained improvement.

In answering the initial question, improvement is in our DNA; we do know what needs improving and we do what we can.

Do we really need patient feedback?

As I started to engage with PET, I was involved in collecting patient feedback, part of the volunteer role. This meant talking and listening to patients to understand their experience of being a patient and how they would have liked things to have happened differently. As clinicians’, time to listen attentively to our patients is a luxury we don’t get. Conversations are clinically orientated which means wider issues may be overlooked. I often listened to the patient with one ear whilst considering the list of jobs I had yet to do. As I listened to more and more patients through the PET process, I became aware of the degree to which my own experiences had biased my feelings towards patients, the public and support staff. As clinicians we are aware of the strengths and areas for improvement within the services we provide, though our knowledge is not exhaustive. All staff have unique insights into healthcare systems and processes which patients do not, however, there will be some gaps that can only be addressed by listening to patients and understanding their unique experience. Given that, collection of patient feedback takes time. PET recommends involving volunteers who act as patient representatives, a valuable approach which enables patients to give open and honest feedback without the worry of being judged.

Learning gained…

1. The appetite for improvement is great
In supporting frontline line teams to use the PET, I have been humbled and inspired by staffs’ willingness to welcome patient feedback to help improve and shape the services they provide. There is no doubt in my mind that NHS staff choose to go to work to do a good job and put their patients first.

2. Imposition is not the way
As clinicians, we can forget or be unaware of what it feels like to be a patient, unless of course we or a loved one has been a patient and acquired an alternative perspective which may help to shape our understanding to some degree. Irrespective of this, each and every team, department and service will provide a unique patient experience. All services will have their own local and specific challenges. This is why PET cannot be rolled out across an organisation or imposed from above. Its success lies in its ability to be useful for teams who can tailor and prioritise the improvements according to the feedback received.

3. PET is mutually beneficial for patients, clinical teams and all levels of management
NHS teams are frequently encouraged to work collaboratively, but despite this, fragmentation of teams and services is a challenge and difficult to overcome. The success of the PET relies on teams (clinical, support staff, managers) being united by a shared purpose, the desire to improve the patient experience. Since it is understood that staff and patients want to be involved and engaged in quality improvement, PET provides a means to bring the patient and staff voice together so that feedback can be acted on and improvements made. It’s not easy but I’ve seen that it can work. In this way, PET brings together shared aims and provides a practical framework through which improvements can be made.

4. PET provides leadership development opportunities
The PET coach is great example of a leadership role. Coaches must be able inspire team engagement, cultivate a shared purpose, empower others to make improvements, listen and create space for others to be heard, maintain momentum and engagement, support the developments of others in their roles. Sometimes leadership opportunities are limited within the NHS despite clinicians moving into positions which requires these skills. The role of a PET coach provides a brilliant opportunity for staff who are keen to develop themselves as leaders. Given that service and leadership development is an expectation of all allied health professionals, this is something I hope would be supported by line managers.

Summary – so what is PET, other than a sleek looking document?

PET is more than a sleek looking document with supporting resources. PET provides evidence-based guiding principles and recognises that the success of teams in actually improving patient experience depends on two factors:

  • The adoption of some founding principles so that PET implementation is organic and not imposed, enabling it to be a person-centred and affirming process.
  • The specific skills which the coach and volunteer bring to the process. The Improvement Academy supports the development of these skills through the PET coaches network and through the provision of specialist training.

Primarily PET is about listening and talking to patients. Coaches are encouraged not to get bogged down in complex datasets, but rather to put people at the core.

Is this for you?

If you are passionate about improving patient experience, have leadership qualities and would like an opportunity to develop them, a desire for change and are interested in learning more about the Yorkshire PET Coaches Network please contact: Laura Proctor or Claire Marsh

Visit our Patient Experience Coaches Network page for more information about the PET Coaches Network, to download supporting resources and the 6 step process.