Issue 7 / 27 February 2012

THE idea of patients making public comments on hospital websites would probably send a shiver up the spine of some Australian hospital administrators, but it’s now standard practice in the UK.

In 2008, that country’s National Health Service set up NHS Choices, a website designed to help patients choose their health services.

Part of the package was that patients could rate services and make comments about the standard of treatment they received — much as a traveller might rate a hotel on TripAdvisor. Ratings and comments are published on the site for all to see.

The move was, predictably enough, controversial. Critics argued it would mostly be used by those with an axe to grind, would provide no meaningful data and would negatively affect relations between clinicians and patients.

Well, research published this month seems to challenge at least some of those arguments.

Researchers from Imperial College, London, found the ratings were far from a chorus of complaints, with 68% being positive. Overall the ratings accorded pretty well with objective measures of hospital performance.

The analysis of 10 274 ratings made in 2009 and 2010 found that hospitals rated in the top 25% had mortality rates that were 5% lower, and readmission rates 11% lower, than those in the bottom quartile.

Those rated in the top 25% for cleanliness had a 42% lower rate of MRSA (Methicillin-resistant Staphylococcus aureus ) infection than those in the bottom quartile.

That doesn’t mean the figures matched up for every individual hospital, something the authors acknowledged while still arguing the ratings could be a useful tool for patients and hospitals.

“The general trend is that where a hospital’s overall performance on clinical measures is good, patients seem to rate it highly — and vice versa,” said the study’s lead author, Dr Felix Greaves in a media release.

This might seem a bit unfair on hospitals that received a negative rating despite good clinical outcomes, but chances are those hospitals do have issues they need to address. After all, if patients think your hospital is dirty, or that the staff are rude, it’s probably better that you know that and have a chance to do something about it, even if your mortality data are just fine.

In fact, one of the things that struck me browsing the NHS Choices site was that negatively rated hospitals could actually improve their image by responding well to the public feedback.

One hospital, which only 50% of respondents said they would recommend to a friend, had garnered a few bouquets but also some pretty negative comments, including this from an anonymous maternity patient: “Cold, heartless staff, think they are above us patients! My pregnancy is high-risk and staff were not cooperating with their colleagues to pass info across. I was made to feel like I was to blame … Because I see a new consultant every time, nobody ever mentions problems and, when I do, I get a sarcastic remark … I really do not feel reassured with the standard of care I will be receiving!”

I’ve edited these comments for clarity and brevity — she had a lot more to say! — but what interested me was how well the hospital responded to them.

The chief executive (or, more likely, an underling in his name) replied publicly, apologising, saying how disappointed he was to hear about her experience, and asking the patient to get in touch by email so that he could investigate the complaints further.

Assuming this wasn’t just PR spin, it made me think that publishing patient complaints and the responses to them could actually enhance, rather than damage, a hospital’s reputation.

Perhaps it’s time the federal government’s MyHospitals website was opened up for public comment.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 27 February 2012

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