User feedback in maternity services

Comments: 3
Patient feedback is an important tool for tracking the experience of those who use NHS services and, through this, the quality of care they receive. It also plays a key role in identifying problem areas and shaping service improvements. Maternity services are using a variety of feedback mechanisms, in addition to national tools, to help them understand women’s experience of maternity services.

This report looks at what maternity services are doing locally to collect, analyse and act on user feedback. It describes the challenges of adopting the different approaches and highlights the features of organisations that are successful in user feedback activities.

User feedback in maternity services | by Lillie Wenzel, Joni Jabbal

Print copy: £10 | Buy

No. of pages: 66

ISBN: 978 1 909029 67 5

Key findings

  • Organisations need to have a clear view on the value and purpose of user feedback, which is supported by all staff.
  • Leaders are key to ensuring that user feedback and actions taken as a result of it are seen as a priority within the organisation and part of a wider culture of improvement.
  • Organisations with the strongest track record in patient feedback use a variety of approaches to collecting their service user’s views, including those tailored to local circumstances.
  • Service users should be involved in all stages of the feedback process, from the development of feedback tools to the design of service improvements.
  • Sufficient time and resources need to be invested in feedback systems so that feedback activities are protected when services are under pressure.

Policy implications

  • Patient experience is a central component of the quality of care in the NHS and therefore patient feedback – a measure of that experience – should be given priority in maternity services.
  • Organisations with the most developed approaches to feedback have adopted a wide variety of tools, tailored to local needs. They have also developed innovative ways of reaching users who may not respond so well to traditional methods of collecting feedback, to help ensure they are hearing from as many users as possible.
  • It is essential that sufficient time and resources are given to feedback activities so that they do not fall by the wayside when services are under pressure.

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#548311 Mark Sadler

Patient feedback is too important to be left to chance. The majority of collection methods used by the NHS are expensive, haphazard and poor quality.

When feedback is collected on-site and in-person with a tablet, or with paper it is significantly positively biased making much of the feedback vanilla, it loses it's punch. You need to highlight variations to select areas to work on for QI projects and these methods wash variation away.

Alternatively if you direct people to a website such as NHS Choices, they simply won't go. Only patients with extremes of opinion (Mr Angry and Mrs Happy) will seek out a place to leave their feedback. This results in tiny amounts of feedback that doesn't even give a true reflection of the experience because feedback hasn't been captured from the middle ground (Mr Content and Mrs Satisfied). Six pieces of extreme feedback per hospital per month doesn't tell us much.

Postal surveys may yield a much better response rate than passive websites, but not everyone can or will walk to a post box. Plus the NHS spends £79million a year on stamps and surely we should make every effort to reduce this?

Even the King's Fund collect feedback from delegates on-site with paper forms, if they were to use the feedback for marketing purposes the CMA would be frowning at them.

eCommerce is still at a evolutionary low point, with TripAdvisor and Amazon still not getting it right, but sadly the NHS is 10 years behind and diligently walking in the same footsteps. New tech and solutions are out there and the NHS needs to take a big jump forward.

At Hootvox we are collecting feedback from patients digitally by email and text message with smartphone friendly surveys. Every patient is sent a survey a day or two after they have been discharged from hospital to avoid bias, and response rates average over 20% which is enough to give a realistic picture of the patient experience.

Of course not everyone has a smartphone or even the internet, so we do have paper and tablet options if only to be inclusive. But the people we are working with are very certain that the future is digital and we are all trying to leave those old methods and bad habits behind.

That all sounds very nice, but can the NHS afford it?
When emails are free and texts cost 4pence the potential for cost savings are huge.

#548312 C Nuttall
Senior Clinical Auditor
Buckinghamshire Healthcare NHS Trust

Our Trust makes use of the Clinical Audit & Effectiveness and the Patient Experience Departments to produce very high quality, well designed surveys for patients. These are sent out to patients, normally by post, with a pre-paid envelope for return. Depending on the demographic of the patients being surveyed we also use Survey Monkey. We can normally expect a return rate of around 50%. Maternity additionally have their own feedback cards on their reception desk, which can be completed and left in a box in the department. We use a variety of different methods. Many of our patients are very elderly and cannot be surveyed by email or smartphone, so we do our best to accommodate them.

#548313 Lindsey Ahmet
Snr. Lecturer Midwifery
Middlesex University

As a midwifery lecturer I have links with units across London and from my previous life as a senior midwife know how important client feedback is in the maternity services and also how hard to capture.
Turn round on maternity units is so fast and new parents so busy shocked , exhausted that immediate responses will be few if it is not more actively sought in an easy manner. Perhaps a number with a good robot response system to catch feedback at different points in the maternity care journey. After all maternity care stretches over several months and locations mainly not within in the Maternity Unit and client satisfaction levels may be very different for community midwives and in-patient care.
Ensuring that communication concerning client feedback is goes to & from care providers e.g. administrators , doctors and midwives is also important. Audits may not pick up on more immediate and perhaps risky issues and clinicians may have "soft Data" like thank you cards or expressions of father's dissatisfaction should be captured. Sadly we are losing the protection of the public role of Midwifery Supervision which many clients and midwives did find useful. Often hands-on professionals will have had reports of mothers ' issues with services but there are not often easy formats to get this intelligence shared upwards . Furthermore as it is many midwives' experience that concerns raised are apparently ignored means that a source of useful information is lost. Feedback to staff could be more effective if provided in digestible chunks rather than long dash board reports only intelligible with the direction of the Quality Assurance Departments. It is always useful to share the positive responses as well as the negative ones. It is also a concern that we do not capture the views of the more vulnerable mothers, particularly those from black and ethnic minority groups who do not speak English. They are more likely to suffer maternal mortality /infant mortality and previous research suggests are likely to be dissatisfied with their maternity care. If new national systems are designed we should ensure that the most vulnerable are the focus and involved in the design of these: if a system can work for the mothers with the most challenges it will work better for all whose views we are trying to ascertain and use.

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