1. What do we need to think about before asking for patient feedback?
Andrew Thompson
University of Edinburgh

2. Policy background
Consensus on patient involvement in definitions, development and management of quality of health care
Focus on patient-centredness
Continuum of political control:
central command and control
laissez-faire
centralised regulatory frameworks (3rd Way)
Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

3. What is the purpose? Public accountability Quality improvement
Macro-level:
system performance management
benchmarking
competition/contestability through markets
Micro-level:
feedback to professionals and managers
acceptability of processes / social model of health
Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

4. Which patients? Specific services
Sub-populations; e.g. sociodemography, illness/condition, geographical
Complainants
Problems:
- exclusion of important groups
- appropriate attribution of responsibility
Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

5. What kind of data is needed?
Existing (secondary) data available?
it probably needs to be modified
Developmental / interpretative study?
qualitative methods; e.g. interviews, focus groups, narratives, patient panels, etc.
Measurement and enumeration?
quantitative methods; e.g. structured surveys
Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

6. What kind of information is needed?
Clarification of concepts / issues
Description of current situation
Description of change
Analysis
interpretation
explanation
prediction
generalisation
Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

7. Reports or ratings? Problems with measuring satisfaction
lack of coherent theory
lack of utility for quality improvement
high reported levels and lack of variation
This has led some to abandon satisfaction in favour or patient reports
Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

8. Problems in satisfaction measures : 1
Theoretical
concentration on cognitive aspects
assumption of continuum from satisfaction to dissatisfaction
Philosophical
scientific reliability and validity
context and interaction between variables
Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

9. Problems in satisfaction measures : 2
Methodological
direct vs indirect evaluation
general vs specific aspects
weak measures – non-discriminating
distorted measures – skewed
simplifying analytical assumption
Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

10. Problems with patient reports
Assumption of objectivity
scientific/bio-medical objectivity vs humanistic/social scientific subjectivity
Who decides on acceptability, if not patients?
patient-centredness gives primary role to patients
Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

11. Horses for courses Micro-level: service quality improvement
professionals and managers need to know where to focus (ratings) and how to improve services (reports)
need information on what is important, as well as the most satisfying/dissatisfying
Macro-level: public accountability
need for a parsimonious set of indicators
evidence (limited) of superiority of ratings
Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006

12. Conclusions
In attempting to solve apparent methodological problems, a focus on reports alone raises problems of an ethical and political nature
Need to embrace subjectivity and work to understand it to create patient-centred services and a coherent theory of patient satisfaction
To decide on value of patient judgements, there is a need to know:
causes of satisfaction and dissatisfaction
meanings and importance of health care and quality
Andrew Thompson Scottish Health Council conference: Getting patients’ views – Are we listening? Are we learning? Edinburgh, 29 March 2006