Patient commenting telephone channel pilot


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Qualitative research report that examines attitudes towards providing unsolicited, "trip advisor"- type comments on NHS services. This research also looked at the impact of service users providing comments by telephone instead of online.

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Patient commenting telephone channel pilot

  1. 1. 1Customer Insight Public information Patient Commenting:Telephone Feedback Line Pilot - Qualitative Research 15th February 2013
  2. 2. 2Customer Insight Public information 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
  3. 3. 3Customer Insight Public information 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.
  4. 4. 4Customer Insight Public information 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.
  5. 5. 5Customer Insight Public information 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
  6. 6. 6Customer Insight Public information 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
  7. 7. 7Customer Insight Public information 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.
  8. 8. 8Customer Insight Public information • 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’. Telephone Feedback Line Pilot – Executive Summary - Feedback On NHS Services
  9. 9. 9Customer Insight Public information Telephone Feedback Line Pilot – Executive Summary - 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.
  10. 10. 10Customer Insight Public information • 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. Telephone Feedback Line Pilot – Executive Summary - Publicising the Telephone Feedback Line
  11. 11. 11Customer Insight Public information Definition of Feedback
  12. 12. 12Customer Insight Public information 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”
  13. 13. 13Customer Insight Public information 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
  14. 14. 14Customer Insight Public information Purpose of ‘feedback’ determines expectations of outcome and channel used Complaint Feedback positivenegative 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)
  15. 15. 15Customer Insight Public information 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)
  16. 16. 16Customer Insight Public information 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
  17. 17. 17Customer Insight Public information Feedback on NHS Services
  18. 18. 18Customer Insight Public information 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)
  19. 19. 19Customer Insight Public information 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)
  20. 20. 20Customer Insight Public information 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)
  21. 21. 21Customer Insight Public information 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)
  22. 22. 22Customer Insight Public information Email/letter Telephone DiscussionFormal 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 (G1: commenters ≤ 40 y/o) Feedback (one way communication) Communication with NHS (two way communication) Communication style
  23. 23. 23Customer Insight Public information Evaluation of the Telephone Feedback Line
  24. 24. 24Customer Insight Public information 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)
  25. 25. 25Customer Insight Public information 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
  26. 26. 26Customer Insight Public information 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 (G1: commenters ≤ 40 y/o) 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
  27. 27. 27Customer Insight Public information 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 (G1: commenters ≤ 40 y/o) 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+)
  28. 28. 28Customer Insight Public information 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 (G4: non-commenters 40+ y/o) 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!’ (G1: commenters ≤ 40 y/o)
  29. 29. 29Customer Insight Public information 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
  30. 30. 30Customer Insight Public information 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)
  31. 31. 31Customer Insight Public information Communicating NHS Telephone Feedback line
  32. 32. 32Customer Insight Public information 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 (G4: non-commenters 40+ y/o)
  33. 33. 33Customer Insight Public information 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
  34. 34. 34Customer Insight Public information •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 (G4: non-commenters 40+ y/o)
  35. 35. 35Customer Insight Public information Next Steps
  36. 36. 36Customer Insight Public information 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
  37. 37. 37Customer Insight Public information Questions and comments to: please quote “Slideshare” in subject line