’Soft’ Intelligence and Online Patient Feedback: Using Care Opinion for NHS Quality Improvement in Scotland.

This PhD will examine the role of patient experience and feedback data (from Care Opinion) in NHS improvement, with a particular focus on the Scottish context, and explore staff and policy-maker perspectives on how to increase its impact.

The Care Opinion website invites patients and families to give feedback to the NHS about their experiences of care. Care Opinion can be a rich source of ideas for improvement, but – like other forms of ‘soft intelligence’ (Martin et al 2015) - working out how to analyse and use the material is a challenge. Staff may be unsure how to respond, how to prioritise issues raised, and how to use unsolicited stories from Care Opinion alongside complaints and other formal feedback methods such as quantitative patient experience surveys.

Some work has been done on how and why Care Opinion is (or is not) used for improvement in England, notably through the INQUIRE project HSDR 14/4/48 (on which Louise Locock is a co-investigator). This has identified particular barriers to using online feedback which is not officially sanctioned and sought by the organisation (Dudhwala et al 2017). However, there has been little independent research in Scotland, where (unlike England) the NHS formally supports Care Opinion as a way of obtaining patient feedback and identifying improvements. Furthermore, the NHS Scotland Data and Measurement team are working with Care Opinion to develop numerical and visualisation tools to help staff identify patterns and themes. Not all Scottish Health Boards choose to engage with Care Opinion, but this active national encouragement provides a very different context to England.

This PhD will use a range of methods to explore the role of Care Opinion in the distinctive improvement landscape in Scotland. The exact study design will be shaped by the student’s interests and early discussions with a patient and staff stakeholder group, but methods and areas of investigation could include:

• a national survey of patient experience leads in Scotland;
• interviews with national policy makers;
• embedded ethnographic observation with Care Opinion Scotland, including tracking individual stories and interviewing patients and staff involved;
• case studies with a range of NHS Boards, sampling for various levels of engagement with Care Opinion. Case studies will include:

- qualitative and quantitative analysis of recent Care Opinion postings and staff responses;
- interviews with staff at different levels in the organisation, from frontline to Board, about their experience of working with Care Opinion data alongside other feedback data sources, to understand their concerns and how they can be better supported to use Care Opinion;
- analysis of ‘changes made’ recorded on Care Opinion, but also staff perceptions of more diffuse impact on culture and behaviour;
- exploration of perceived added value from numerical and visualisation tools where these are being used.

Primary supervisor will be Prof Louise Locock. As well as INQUIRE, the PhD will build on Prof Locock’s recent US-PEx study (HSDR 14/156/06), on how frontline staff use patient experience data for improvement, and a small pilot study with NHS Grampian on staff responses to Care Opinion. The second supervisor is Prof Marion Campbell who has led a number of research projects on the integration of patient/public perspectives in clinical service and research design. Care Opinion Scotland will be active partners and are willing to share data and expertise, as well as host the student for a period of fieldwork. NHS Scotland is also supportive and will be invited to be represented on an advisory panel. The study may also draw on expertise in the Aberdeen Centre for Health Data Science, which has special interests in natural language processing and knowledge graphing as methods to summarise and re-present data from a range of sources.

The studentship has been funded by the THIS Institute (The Health Improvement Studies Institute), supported by the Health Foundation. The successful candidate will become part of the THIS Institute community and will attend academic events held by THIS at the University of Cambridge. The first event to attend is 3-5 September 2019.