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  • GREATix: Improving culture, wellbeing and patient safety through positive feedback

    PatientSafetyLearning Team
    • UK
    • Interviews and reflections
    • New
    • Health and care staff


    Ben Watson is a Strategy Implementation and Quality Improvement (SIQI) Manager in the Scottish Ambulance Service. He is currently responsible for supporting operational services in the West of Scotland, to see how they can improve patient care, existing processes and develop new ways of working that benefit both staff and patients.

    In this interview, Ben explains why they’ve started collecting positive feedback through a peer-to-peer system called GREATix. 

    Questions & Answers

    What is GREATix?

    GREATix is a reporting mechanism for capturing positive feedback. It is aimed to be ‘for staff, by staff’ to encourage peer-to-peer recognition. This could be for anything. An incident you have attended where a colleague has gone over and above for a patient, or something as simple as a colleague who takes the time to ask you if you’re ok after a tough job. It’s aimed at recognising what is meaningful for you rather than what is seen as ‘expected’ praise. 

    How did you first hear about it?

    Capturing positive feedback from peers isn’t new and I’m certainly not the brains behind GREATix, which came from the concept of ‘Learning from Excellence’. I became aware of it at an Improvement event last year where Dr Sara Robinson, a Consultant in Emergency Medicine, presented on GREATix.

    This coincided with the development of our organisational wellbeing strategy and we were looking to deliver it as part of our peer support and learning from events programmes.

    Why did you want to use GREATix?

    It’s been a tough year for public services and it’s understandable that people working across these services are feeling additional stress and pressure to deliver excellent standards.

    Despite the amazing work that goes on every day, most of the functioning feedback mechanisms in place are designed around negative feedback or risk management. This has a detrimental impact on culture and wellbeing in a workplace. Introducing something like GREATix provides a method for saying thank you that will help to tackle some of that, and hopefully put a positive light on the hundreds of things that go well rather than the small number that don’t. 

    I also think it is important that this is a peer-led system where the feedback is not led by hierarchy. While it’s always nice to be recognised at any level, there is something a bit more special about being recognised by your peers. 

    How will you use the positive feedback collected by GREATix to improve patient safety?

    As an improvement team we regularly review the GREATix that are submitted. The staff member/s nominated for the GREATix receive an e-certificate, but we also theme the submissions. These themes include things like patient experience, patient care and peer support.

    We delve a bit deeper into those that are related to patients to understand what has happened and see if there is anything we can learn. This learning is then presented back to the organisation through forums such as our learning from events and patient safety groups and can influence best practice, education and improvement projects going forward. 

    How did you go about rolling it out and were there any challenges?

    The main challenges for us were taking the idea from a more static environment, such as a hospital, to a mobile healthcare service while keeping it as simple as possible for staff to use. Then it was about the communication process. We recently started our migration to Microsoft 365 which gave us more functionality to make things a bit easier. It gave us access to Microsoft Forms which is straight forward to use and generates links for websites, QR codes etc so it can be advertised easier. 

    Initially, it was launched in line with our new intranet site and was mentioned in our Chief Executive’s weekly bulletin to help to increase awareness while we were getting posters printed for the stations and offices. At the same time, I put up a tweet with a video I made with a bit more information on it which seemed to land well. 

    Like most ambulance services, our crews are under a lot of pressure and can go extended periods out of station. To tackle that, we have made wipe down stickers with a QR code on to go on the sun visors of all the vehicles and for computers in our control rooms. This is to make it accessible as possible, particularly while that good deed/act is still fresh in the person’s mind. 

    Were you able to customise it? If so, how?

    I think that’s the brilliant thing about GREATix. As it’s a concept, it can be as easy or as complicated as you want to make it. You could have it online, as we have done, but could have a box on the station with a sheet of paper that people could post. 

    I think it’s about keeping the form simple. If you have 25 detailed questions people are less inclined to complete it. Our form is 8 questions, most of which are things like name, station, do you want to remain anonymous etc. The main question we have is ‘What did the person do that was great?’ and a second optional question ‘What could the organisation learn from this?’. 

    Is it only for colleagues in the Ambulance Service? 

    At the moment we’re in the initial phase, which is for ambulance staff. The form itself is already open to anyone and it can be used but we’re currently only actively promoting this for Scottish Ambulance Service staff. 

    Depending on how this goes over the next few months we are planning on expanding it further. We are looking at providing posters and stickers to the A&E departments, some of the bigger Minor Injury Units, Community First Responder Schemes, partnering universities etc. We will also do some engagement with their staff to encourage its use.  Some of the feedback from colleagues in these areas has already been extremely positive and it’s something we’re looking forward to. 

    Do you have any advice for others who are keen to use GREATix as a tool?

    The only advice I have is to just get on and do it. It needs to have a bit of momentum to show it’s not just a tick box exercise. We don’t have any dedicated resource to this so have a plan A, B and C for making sure this work is seen through from start to finish. 

    Is there anything else you would like to add?

    Thank you for the opportunity for us to showcase this piece of work and if anyone would like more information on setting up GREATix, I’m more than happy to share what we have done and provide more information on how we have gone about it. Feel free to get in contact, my email is Ben.watson1@nhs.scot or message me on Twitter @BenJWatson86   

    Note: The term GREATix was coined by Dr David Sinton, after working with Adrian Plunkett who set up the Learning from Excellence Movement

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