When Anonymity is a Blocker

 One of the most common things we hear at Care Opinion is:

"We'd love to respond, but we don't know who this person is."

This is certainly an understandable reaction. Healthcare is built on identification: identifying patients, appointments, clinicians, medical records and much more. When something goes wrong, our instinct is to ask, who was the patient? Which appointment was this or which staff member was involved? Anonymous feedback throws a spanner in the works.

So how should we overcome this? And why do we even need anonymous feedback in healthcare?

These are exactly the questions we sought to explore in yesterday's webinar: Rapid Response Training: When Anonymity Is a Blocker

 Anonymity is important in healthcare feedback for a couple of reasons. 

The first is that if we want access to the full range of patient experiences, then we need anonymous feedback. Without anonymous feedback, we risk sampling bias where we only hear from patients who feel comfortable revealing their identity.

The second reason is psychological safety. Many patients worry about future care or creating more stress during what has already been a difficult experience. Others don't necessarily want an investigation. They simply want healthcare to know what happened so it doesn't happen to someone else.

A 2020 study by Locock and colleagues explored how healthcare staff in Scotland experienced anonymous Care Opinion feedback and described what they called the anonymity paradox: patients valued anonymity however staff often experienced this as a barrier. 

Perhaps, then, our first question with anonymous feedback should be: What is this story asking us to learn?

This also helps us think about how we respond. Broadly speaking, anonymous feedback tends to fall into two categories: 

The first is personal stories.

These describe an individual's healthcare experience. They often relate to a particular appointment, admission or interaction with staff, and may include concerns about treatment, communication or staff decisions. Stories such as this one. 

The second is environmental stories.

These are less about one person's care and more about the healthcare environment itself. They might highlight issues with breastfeeding facilities, parking, signage, accessibility, waiting rooms or communication processes. These are often issues that affect many people rather than one individual. Stories such as this one. 

With environmental stories, we often don't need to identify the author to respond. Their anonymity becomes almost irrelevant because the issue could affect many future families. Personal stories, however, are understandably more difficult. These stories may require reviewing the medical record, identifying the consultation and speaking with the clinicians involved. 

So how should we respond?

We need to remember that there are really two conversations happening at once. The first is directed to the author, and the second is directed to the public.

So while we may tell the author they need to contact us, we can also explain publicly what is being done with the feedback, why further contact is needed and - most importantly - give people a glimpse behind the curtain. We've highlighted this before, and Chloe Keogh's response is a great example (here).

So although anonymity can make responding to personal stories more challenging, we must always ask ourselves: What do we want the public to learn from this story? 

Please provide feedback for the webinar here: Rapid Response Training – Fill out form 

Watch the full webinar below: