patient commenting telephone channel pilot

1 Customer Insight Public information

Patient Commenting:Telephone Feedback Line Pilot

- Qualitative Research

15th February 2013


Patient Telephone Feedback Line Pilot –

Research Report: Table of Contents

3 Background and Objectives

5 Research Method

6 Key Learnings

7 Executive Summary

11 Definition of Feedback

17 Feedback on NHS Services

23 Evaluation of Telephone Feedback Line

31 Communicating the Feedback Line

35 Next Steps


Background

• The NHS Choices website currently gives the opportunity for customers to

give feedback on their service experiences. The most recent performance

report suggests the number of comments left appears to be levelling out at

around 5,000 per month across all NHS services.

• On-line feedback appears broadly in-line with other service sectors that

encourage customer comments and is similarly skewed towards younger,

female, higher SEGs. Preliminary research among a nationwide sample of

adults indicates that while on-line feedback is the preferred channel for half of

those interviewed, for a third of users, an opportunity to leave comments via

the telephone would be the preferred option.

• To extend reach, the NHS is in the process of piloting an 0800 number on the

NHS Choices website that will allow users to give comments directly to an

operator. The Customer Feedback Line will extend the opportunity to provide

and potentially encourage feedback from NHS customers in groups that are

harder to engage on-line.


Research Objectives

A research programme was designed to:

• Explore consumer attitudes to providing feedback comments in general

• Understand drivers for commenting and expectations of what will happen as a result i.e.

• How does commenting on NHS issues differ from feedback in other sectors?

• Determine the impact of channel on the willingness to provide feedback and on the type of feedback provided

• Evaluate the telephone line user experience with opportunities to improve

• Explore circumstances when customers would consider using telephone to comment

• Explore how and where should the service be publicised to maximise reach

• Who would use it and why?

• Understand customer expectations of what will happen following their call.


Research Method

• 4 x 1.5 hour focus groups with NHS users that have never provided feedback via NHS Choices

• Groups were split by experience of commenting

• 2 groups had not fed back / commented by any means in the last 12 months

• 2 groups had provided feedback for goods/services but not about NHS services

• And age

• 2 groups aged under 40 years of age

• 2 groups aged 40+ (including at least 2 retired)

• Groups were mixed gender and ethnic background

• Half the groups were held in a viewing studio, half in-home

• 2 groups were held in Merton: current 111 pilot area

• Group respondents were pre-tasked to call the phone line and leave a comment on a recent NHS service experience

• 4 x 30 minute telephone interviews were held with NHS users who called the feedback line after seeing a pop-up on NHS Choices


Telephone Feedback Line Pilot

- Three Key Learnings

‘Feedback’ is defined by the general public by organisations like

Amazon and Ebay - They do not understand the benefit of providing

feedback within the NHS

There is no clear motivation for NHS Users to provide feedback on

services - They do not believe patient feedback can influence change or

help patient choice within the NHS

A Telephone Feedback Line will bring in some additional

commenters - But without communicating how and why consumers

should use it, risks being dominated by potential on-line commenters,

complaints and information requests


Telephone Feedback Line Pilot – Executive Summary

- Nature of Feedback

• Commenting and on-line reviews of products and services have become an accepted part

of on-line relationships with suppliers. Led by Amazon, Ebay and sites such as TripAdvisor

even non-commenters are likely to check customer feedback as part of their own purchase

decisions.

• Younger consumers have generally bought into the benefits for both individuals and the

wider community of using and sharing comments. Older generations (60+) are less likely to

be actively involved in feedback but recognise the value of other people’s opinions via

established reviewers like Which or general word of mouth.

• NHS customers, accept, in principle, that a similar model for logging and posting

customer feedback and reviews could be established for NHS services. In practice, this is

inhibited by fundamental perceived differences between an NHS provider/patient relationship

and a commercial supplier/purchaser relationship. Patient/NHS partnerships have stronger

emotional and personal elements that do not fit neatly into the familiar feedback model.

• There is a need to educate NHS users of the end benefits of sharing and using patient

comments to encourage participation. Expectation of achieving service improvements via

patient feedback is currently low.


• There is currently low perception of patient choice within the NHS that will drive customers

to search or post feedback. There is a strong belief that choice of GP and hospital is beyond their

control therefore there is no recognised requirement to search for reviews and recommendations .

• Providing a telephone feedback service risks attracting users that may have otherwise

posted comments on-line - particularly among older consumers. Speaking to someone, gives

confidence that comments are ‘listened to’.

• A telephone option may attract new commenters that would perhaps not have left feedback

at all. Customers that intended to leave comments, but never got round to it, may be prompted to do

so by a telephone number.

• A telephone feedback line needs clear signposting to minimise use as a channel for

complaints. Customers naturally differentiate feedback from ‘complaints’ that require a formal

response, paper trail and resolution. NHS users would not generally use a telephone service for

this, but may use the channel to kick start the process.

• Older NHS users, in particular, have difficulty in differentiating negative feedback (to assist

other NHS users with choices) from complaints. This group requires educating that ‘constructive

criticism’ is valuable to the wider NHS community and will improve, not damage, ‘their NHS’.


- Feedback On NHS Services



- Use of the Telephone Feedback Line

• There are concerns across customer groups of the likely fallout from leaving negative

feedback on local services. Feedback on purchases/services in general is considered

impersonal and anonymous. There are worries that leaving feedback on local hospitals, GPs

and dentists may have repercussions next time they visit.

• The Telephone Feedback Line was overall, considered well staffed and simple to use.

Where it worked well, the process was short, clear, and provided satisfaction for users that their

comments had been listened to and recorded accurately

• Call handlers are attentive, personable and willing to help even when faced with

problems with the system. They were not considered or expected to be ‘medical experts’ but

vastly exceeded expectations from a central call-handling facility

• Call handlers had difficulty in locating some hospitals/practices at the beginning of the

call causing delays and frustration for users. Operators are reliant on the information given

by customers to identify targets for feedback. Call handler training on managing searches will

correct some issues, although evidence indicates that details of service providers are not always

up to date.


• The request for demographic classification information was considered by some users to be

intrusive and the necessity questioned. Asking about ethnic background and age in particular

concerned some respondents, especially when asked at the beginning of the feedback process. The

need to leave a telephone contact number also caused unease.

• Accessing the pilot telephone line via mobile phone was expensive (14p per minute). Coupled

with delays caused by inability to locate the target feedback location, completing demographic details

and checking content, users viewed the service as an expensive means of leaving feedback.

• NHS users interviewed in the focus groups had very low/no awareness of the NHS Choices

website. They were therefore not aware of an existing ‘NHS information sharing community’ in the

context of which commenting on their own experiences may seem more relevant

• Respondents believed that communication of the feedback line should be at local points of

service and messages should be rooted in ‘your NHS’. Service users appreciate the benefit of

sharing their experiences if they can see it will impact on improved services for the local community

• NHS users do not see themselves as ‘customers’. They expect language used in communicating

the Feedback Line to be appropriate to their relationship with NHS services. They wish to hear that

the NHS is ‘listening’ to patient opinions for the benefit of the wider NHS user community.


- Publicising the Telephone Feedback Line


Definition of Feedback


Feedback is ‘a chance to give a personal

opinion’

Individual definition of ‘feedback’ determines motivation to comment, level of engagement, content and expectation of outcome

Influenced by

demographics, internet

activity, feeling of social

responsibility and

desire to be heard

“response”

“good experience”

“complaint”

“constructive criticism”

“chance to improve service” “a rant”

“a thank you”

“praise”

“grievance”

“dissatisfaction”

“satisfaction”

“endorsement"

“warning to others” “venting”

An unprompted opportunity to give feedback will skew towards those holding

strong feelings and/or those that already buy into the idea of a ‘feedback loop’

By nature people tend to

moan more than they

would say ‘thank you’

(female 40+)

“helps other users”


Feedback is associated primarily with on-line

commercial websites

Used to check out goods before purchase:

More reading than posting feedback

Providing feedback fundamental to buyer and

seller ratings. Incentive to feedback

Useful research tool. Exceptional experience or wish to

‘balance’ negative comments triggers posts

• Feedback/reviews part of a

website culture

• High awareness even

among ‘non-commenters’

Banks

Mobile phone providers

Restaurants

Feedback requests from retail/service providers are treated more sceptically…

• Just ticking boxes

• Not really listening

• Doubts will lead to service improvement

Definition and credibility of ‘feedback’ varies according to the organisation that requests it. Customers

are more likely to engage where feedback is considered to be intrinsic to the customer experience and

benefits, either personal or for the wider community, are recognised


Purpose of ‘feedback’ determines

expectations of outcome and channel used

Complaint

Feedback

positive negative

Praise

•Personal

•Emotional

•Considered

•Address to individual (or)

•Proof reaches individual

•Small Gift/‘thank you’

•In person

•Letter/phone call

•Personal

•Emotional

•Considered

•Address to individual (or)

•Head of organisation

•Paper trail required

•Response essential

•Email

•Or Letter (older)

•Venting

•Warning to others

•Impersonal

•Publication expected

(younger)

•Usually prompted

•No response required

•Generally on-line

•Express satisfaction

•Support for service

•Impersonal

•Wish to be counted

•Publication expected

(younger)

•Usually prompted

•No response required

•Generally on-line

Complaints carry a greater momentum and will be initiated by any channel available –

including a feedback line. On-line commenters just hope feedback will ‘filter through’

A complaint is more

between you and the

institution whereas

feedback is usually in a

public forum

(G1: commenters ≤ 40 y/o)


Engagement in feedback depends on a

persuasive reason to participate

What will be achieved?

Who will benefit?

Change in service

Change in behaviour

Self

All users/customers

Unlike complaints, no hard evidence of change or benefit is required by consumers to

drive engagement, but motivation to engage must be credible as well as persuasive

Organisation

Compensation/reward

Altruism - helping others

Develops customer/supplier

relationship

Key Drivers - Belief that feedback will have

impact is important

Help shape future experiences

Encourage/discourage use

That’s what you hope isn’t

it? If you’re giving

feedback there’s going to

be a reaction: something’s

going to happen

(G4: non-commenters 40+ y/o)


Definition of and attitudes to feedback were

similar across both occasional commenters

and non-commenters

• Even non-commenters were familiar with requests for feedback

• Most non-commenters had experience of giving feedback at some

point (even if a letter or personal ‘thank you)

• Greatest differences seen across age groups

• Younger non-commenters would provide feedback in principle – just

lacked motivation

• Over 60s in general were less inclined to participate in feedback

• 60+ Commenters had generally done so by letter/phone to complain,

say ‘thank you’ or had provided feedback when prompted


Feedback on NHS Services


NHS customers have some difficulty in

understanding drivers for feedback in the context of

NHS services

What will be achieved?

Who will benefit?

Change in service

Change in behaviour

Self

All users/customers

Low belief in being able to influence change within the NHS is a major barrier to

engaging in feedback with NHS services

Organisation

Best achieved via personal

complaint/thank you not feedback

‘An ideal’ but doubt relevance of

personal experience to wider NHS

community

Doubt that NHS organisation will be able

to effect change based on feedback

Key Drivers

Customers currently feel influencing

change is beyond their control

Low awareness and credibility of choice

within NHS services

Your relationship with the

NHS isn’t a purchasing

relationship; it’s not about

spending money, it’s

about being treated

(G2: non-commenters ≤40 y/o)


So… Feedback, as understood by the general

public, does not currently fit naturally within

the NHS space

•Not a commercial customer/supplier transaction

•Most experiences of NHS services are both personal

and emotional

•Low expectation that feedback will result in changes to

services

•Awareness and belief in ‘consumer choice’ within NHS

services is low

NHS customers doubt credibility of ‘end benefits. Neither assisting others with

consumer choices nor driving improvements are currently seen as achievable

outcomes

• Who will be interested?

• What will it achieve?

It’s a bit different with the

NHS because you can’t

pick a hospital

(G2: non-commenters ≤ 40 y/o)

For a service where I

know the people

personally then I would

rather say thank you

personally (G4: non-commenters 40+ y/o)


NHS customers’ affection for the NHS means

they don’t want to give negative feedback

• Far more leeway allowed for delays and inconvenience than in

commercial customer/supplier relationships

• Concern that any criticism will impact on their future use of NHS

services

• Communication with the NHS services is generally triggered by a

serious ‘complaint’ requiring action and a satisfactory resolution

• Response is personal and directed

• Older NHS customers, in particular, do not yet understand the

value of ‘constructive criticism’ in the context of shaping

improvements in ‘their NHS’

NHS service users require educating of the benefits of ‘constructive criticism’. There is

low acceptance that by sharing experiences they have the power to shape the future of

‘their NHS’

I couldn’t go and

complain to my

doctor… there’d be

this friction between

us

(G3:commenters 40+ y/o)


Customers are happy to give positive feedback but

want it to reach the people responsible

• Low levels of expectation of NHS services (mainly hospital and

GPs) means that when services go well it is ‘as it should be’

• ‘Customer delight’ when services far exceed expectations is

generally rewarded in person to the individual provider

• Older NHS users, in particular, recognise the power of a ‘thank

you’ but are the most likely to reward providers either verbally or

with a small gift

• But recent potential closure of local services has motivated some

(younger) customers to add their support on-line – a wish ‘to be

counted’ among other supporters

The general public retains a strong affinity to ‘their NHS’ and are prepared to say ‘thank you’

at a personal, local level. Customers need to be persuaded that sharing their positive

experiences more widely can benefit the broader community of NHS users

I just wanted to give a

little support to them

because obviously

they are facing

difficulties at the

moment (G1: commenters ≤ 40 y/o)


Email/letter Telephone

Discussion Formal

Social Media

Like

Website

Share

‘Feedback’ channels are not those where

communication with the NHS will usually be carried

out

• After discussion, most respondents could be persuaded of possible benefits of

giving feedback on NHS services – but younger NHS users, particularly, feel on-

line is the most appropriate channel

• Response from many older NHS users (60+) shows many will prefer telephone,

contact, but this group requires greatest education about being involved in

patient feedback and therefore less likely to use unprompted

I kind of realised this is

[call operator] transcribing

what I’m saying to go on a

website, whereas I could

have just done that myself


Feedback

(one way communication) Communication with NHS

(two way communication)

Communication

style


Evaluation of the Telephone

Feedback Line


There is no perceived requirement for a

telephone feedback line by NHS customers

• But the opportunity to contact the NHS

via telephone has strong appeal to the

less internet savvy

• Older customers in particular welcome

the chance to complete the transaction

via telephone and will use the service if

provided

A ‘feedback’ line will need clear routing/signposting to ensure that it does not

become an entrance point for a wide range of queries and complaints

I like immediate contact.

The human voice, or

preferably face-to-face,

rather than something that

is happening out in cyber

space (G4: non-commenters 40+ y/o)


Though introducing a telephone option generated

many calls, only a minority was genuine ‘feedback’

• Used principally as another means to register

complaints or clarify issues with the NHS Choices site

• Only customers calling to leave feedback were

referred onwards to participate in our research

• None of the focus group participants would have used

the feedback line without being tasked to do so

• A small minority said they would consider using the

telephone feedback line again in the future

• But a majority projected they would ‘cut out the middle

man’ and leave any feedback on-line

The telephone feedback line is likely to prompt reverse channel shift. Much of additional feedback

generated (ie would not consider on-line) is more likely to be from (older) NHS users that require

most convincing of the benefits of providing feedback

Call Type No. %

Feedback 41 20% 31 respondents to survey (76%)

Complaints 26 13%

Other 139 67% • Examples: • enquires about hospital appointments and test results • wanted to find out their NHS number • unable to access Choose and Book

• GP surgeries/ dentist new registrations…

Call breakdown as at beginning of fieldwork


Benefits of telephone communication…

Personalises the service – a ‘human touch’

Reassured they are being ‘listened to’ – a two way conversation

Feel issues are owned and therefore may go further

Someone to hear and react to points caller wishes to share

An opportunity to ‘rant’ to a sympathetic ear

I didn’t want to

complain. It was more

of an opportunity to

have a bit of a rant


I think, to be honest, if you’re doing it

on the phone, you’re probably just

ranting. You want to get it out of your

system and you think ‘I want to talk to

someone’

(G4: non-commenters 40+ ( y/o)

After using the feedback line, NHS users can see a role for the service


Experience of using the Telephone Feedback

Line was overall strongly positive

All call handlers were attentive, sympathetic and

cooperative

Experience was a long way from mass market, high

volume call centres users feared

Staff were not expected to be medical ‘experts’ but

handled calls intelligently and flexibly

Re-checking comments given at the end of the call

provided reassurance that users had been listened to

and would be accurately represented.

Highlights…

Most calls answered in a couple of

rings

Process clear and simple to use

Left users feeling happy after positive

feedback and ‘unburdened’ after

negative feedback

2 respondents felt comments could

contribute to saving local services

If you’re talking to a

human being,

someone’s literally

listening to you


I just feel if you speak

to a person you feel

as if your comment

will go somewhere

rather than just to a

space

(Female 40+)


However, there are areas to improve …

At busy times phones were not answered quickly

Request for personal details causes suspicion

Demand for ethnicity, age and phone number sits poorly

with anonymity promised

Delays experienced due to inability to find target

hospital/practice (calls lasted up to 45 mins)

Customers are unlikely to know services by postcode

Process not flexible enough to deal with comments

involving several sites

Some frustration at inability to ‘name names’ in feedback -

especially when wanting to say ‘thank you’

Call centre operators may benefit from specific training to

manage search process

I was a bit disappointed [not

being able to give names]. I

thought it was a waste of time


I would have had to make 7 or 8

statements for various people in

various departments in various

hospitals because she had no

‘catch all’ box

(Female, 40+)

I would have preferred to use

the website – it would be

much quicker

(G2: non-commenters ≤ 40 y/o)

I did actually think ‘I hope she’s

like spelling everything

correctly!’



Specific points to focus improvements …

Eliminate requirement for demographic details up front and

explain reasons for collection

Explain request for a contact telephone number

Minimise delays caused by address searches

Ensure provider details and addresses are up to date

Eliminate mobile call charges: 14p/minute

Provide a facility to attribute comments across several services

and locations if required

Ensure call handlers are trained to deal with handling

complicated spellings and medical conditions to avoid awkward

questions


There is no expectation that feedback

requires a personal response

• Only complaints require acknowledgement and

reassurance the matter will be responded to

• Feedback is viewed as ‘one way traffic’

• Commenters expect that their comments will

appear on site (but have no strong feelings

about it)

• They assume their comments will ‘filter

through’ to the wider NHS community

• A ‘thank you for your feedback’ at the end of

the process would be a nice touch

• NB respondents were not

current users of the NHS

Choices Website

• Although many post-

interview said they would

look in the future

If the purpose of the feedback is for

people to look at the website and read

reviews, if you like, I’m not sure how

valuable that is for somebody like me.

But if it’s to get the information to the

right people and to improve services –

just to say ‘Well done. We all like this…’

then I’m behind that. Absolutely

(G3: commenters 40+ y/o)


Communicating NHS

Telephone Feedback line


Choice of name / description of the feedback line

has a strong impact on service expectations

• Customer Service Line has negative associations for

many

• Low service expectations

• Staff expected to be poorly trained

• Commercial: Banks, telephones, utilities

• Unlikely to end in a satisfactory resolution

• Suggests a ‘two way’ service. Feedback = 1 way

• 111 service was recognised by a minority of Merton

respondents and could include a feedback line

• Would need to be clearly routed

• Purpose of broader 111 service unclear at this stage

• ‘Feedback’ clearly defines the purpose of the line

• Although still faces issues about providing feedback on NHS

services

111 sounds too much of an

important number for a

feedback line! (G2: non- commenters ≤ 40 y/o)

From my experience of

customer service you expect

nothing and you really get

nothing



NHS users believe the feedback line should

be publicised at point of service

•Service users are in a ‘patient’ mindset

•Time to read and absorb communications

•Posters and leaflets in waiting rooms or messages on appointment cards would be appropriate

•Should be promoted locally to emphasise local services will benefit

•NHS users are realistic enough to assume that a large scale TV campaign is unlikely to be funded by the NHS!

Given most feedback is anticipated to be on local services, NHS users believe they should be

encouraged to become involved also at a local level - an opportunity to influence community

services that they or their families use


•An emotional appeal to the affection felt for the NHS will resonate strongly

•Motivation to participate should be altruism rather than reward (distances ‘feedback’ from ‘complaints’)

•NHS users buy into the idea of health services that (should) provide a positive experience for all

•They are open to persuasion that by providing feedback they are playing their part

•Communications should offer motivating end benefits that are credible and achievable

•Language used to describe the NHS/user relationship must avoid suggesting a commercial customer/supplier relationship

• ‘customer’ is strongly disliked: ‘patient’ preferred

• ‘listen’ and ‘hear’ reassure that comments will go further

• ‘comment’ ‘review’ and ‘feedback’ all carry different expectations

Key message should put the focus on

actively helping ‘your NHS’

Your relationship with the NHS isn’t a

purchasing relationship. It’s not about

spending money it’s about being treated

(G2: non-commenters ≤40 y/o)

It might make you feel civic

minded or helping your

community

(G1: commenters ≤40 y/o)

People need to understand

what it’s for and if it is to

make the NHS better



Next Steps


Moving forward, customer insight would

recommend …

Clearly position the telephone line as a ‘feedback line – emphasise the importance of

‘reviewing’ and ‘sharing’ to differentiate it from complaints

Target, primarily, older NHS (60+) users that would prefer a human voice to ‘guide

them through the feedback process’: younger users can be directed on-line

Offer those that engage in feedback credible and achievable benefits for participating

in service feedback: an opportunity to influence change

Educate NHS users about choice within the NHS to motivate them to share their

experiences with the wider NHS community: emphasise ‘constructive criticism’ is as

valuable as positive feedback

Ensure the telephone feedback process is not prolonged unnecessarily (hindered by

address searches or spelling out conditions or procedures). The focus should be on

feedback content not classification facilitated by well trained staff

Publicise the telephone line as ‘helping your NHS’ a means of sharing personal

experiences with the local community to help shape the future of their local services


Questions and comments to:

[email protected] please quote “Slideshare” in subject

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mailto:[email protected]

patient commenting telephone channel pilot

Health & Medicine