Public online-feedback and organisational culture – 9 levels of development

Public online-feedback about health care is now an everyday occurrence. While some organisations embrace such feedback with enthusiasm, others are uncertain or even hostile.

Likewise, some organisations see online feedback as a key part of the way they relate to their service users, learn about what needs to change, and even drive quality improvements. Others respond only with reluctance.

Based on their years of experience working with healthcare organisations, the Patient Opinion team in the UK have done some interesting reflective work on the “levels of development” for an organisation working with online feedback.  They have deduced 9 types of levels from their experience.  Here they are:

Levels of development

Level 1 - Resistance or defensiveness

Org. culture is resistant or defensive about online patient feedback. No engagement with Patient Opinion (PO)

Level 2 - Controlling or organisation-centric

Tolerates public feedback but prefers feedback to be delivered privately and "in-house". Not registered with PO. No public indication that stories have been read

Level 3 - Acceptance

Accepts public online feedback and responds. Feedback is seen as a threat to reputation, and to be managed. May be registered with PO. Responses often impersonal and defensive

Level 4 - Engagement

Org. goes beyond acceptance to a more active engagement with online feedback. Encourages feedback via PO. Responses will often come from an identifiable person, and be empathic

Level 5 - Initial commitment

Org. sees online patient feedback as a positive force for quality improvement in some or all of its services. Org. makes a clear commitment to deeper engagement with and support for PO, by actively subscribing

Level 6 - Widening staff involvement

Org. shares online public feedback more widely with staff, but mainly as recipients of feedback rather than responding. Many staff are reading relevant feedback about their services

Level 7 - Widening staff involvement as active participants

Org. encourages widespread involvement by staff in being aware of, using and responding to feedback. Many staff are reading, and posting responses. Responses come from a member of staff close to the specific service or area of care

Level 8 - Everyday Patient Opinion

Awareness, use of and learning from public online feedback is embedded at every level of the organisation. PO is integrated into the everyday care and culture of the organisation

Level 9 - The absence of fear

The culture of the org. has been transformed by user feedback and staff engagement. Public feedback has become core to professional practice

How might this be helpful?

Why might it be a good idea to try to set out the above “levels of development” for an organisation working with online feedback? In part, this is to help us at Patient Opinion in seeing where we can improve our service to our users.

But it is also to encourage reflection and debate on the part of organisations using Patient Opinion. We hope that this will challenge organisations to do more with online public feedback, and also that organisations will in turn challenge us to improve our thinking too.

So this document is shared in a spirit of constructive debate. It should develop and change as our understanding develops.