This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. James talks to us about the value of patient feedback in boosting morale and enabling organisations to make real patient safety improvements. He also describes the power of the unique perspective patients have on safety, and asks how we can use this insight to shift culture and provide safer care.
About the Author
Dr James Munro is Chief Executive of Care Opinion, the UK’s non-profit online feedback service for health and social care. His background is clinical medicine, public health and health services research.
After 13 years in health service research at the University of Sheffield, James joined Care Opinion (then Patient Opinion) in 2006 to help build the public online feedback platform which now serves the UK, Ireland and Australia. As chief executive since 2014, he leads a small team united by a passion to make it safe and simple for people to share feedback about their care in ways which lead to learning and change.
Questions & Answers
Hi James. Please can you tell us who you are and what you do?
I’m James Munro, Chief Executive at Care Opinion, a non-profit social enterprise which I’ve been involved with since its inception 18 years ago. Prior to that, I started my career as a hospital doctor before moving into public health and health services research.
What is Care Opinion and how is it being used by providers to improve patient care and safety?
Care Opinion is a UK-wide online platform that allows people to share their experiences of health and social care. People post their stories, we publish them, and then hopefully staff read them and respond. Hopefully the feedback benefits individuals and teams, helping them make changes to services, solve issues of quality and safety and improve care. About 70% of the stories shared are positive and one of the big impacts we see is lifting staff morale.
We want people to find out about Care Opinion at the point they need it, when they have recently used healthcare services, so we rely on healthcare staff to tell people about the platform. Some healthcare professionals might invite feedback from individuals, and some organisations build Care Opinion into their administrative systems, for example by including links to the platform in patient communications. We also use social media to engage with patients and healthcare organisations.
How did you first become interested in patient safety?
I started my career seeing patient safety as quite a technical area that focused on complex interventions in areas such as surgery or chemotherapy. But reading the stories that people share about their care on Care Opinion, I came to realise how integral patient safety is to the healthcare journey. The stories we collect show that patients see patient safety issues and risks, as well as opportunities to make things safer. Seeing this patient perspective is what really got me interested in patient safety—you approach it very differently when you see it through the patient’s eyes. A study by researchers at the London School of Economics last year showed how vital that patient perspective is as it showed that patient reports about patient safety are a better predictor of hospital mortality than staff reports.
Another insight I have gained from reading thousands of stories over the last 18 years, is that what makes patients feel safe or unsafe may be quite different from the technical issues that might be in the minds of clinical staff. For most patients, the issues are far more relational; they feel safe if they are listened to. Patients are internally asking questions about the healthcare professionals they engage with, firstly “Do they care about me?” and secondly “Are they taking me seriously?”
I have also come to see that very often patient safety is an issue of team culture, rather than just techniques and technologies. That culture can have a huge effect on safety as it determines how teams communicate, whether information gets passed on, whether staff are stressed, whether they trust each other and whether there is relational dysfunction. And patients see that too. If a patient has told a staff member that they are allergic to penicillin, but five minutes later a nurse turns up with penicillin tablets, they will rightly feel unsafe. Increasingly, I’m really interested in the impact of people’s feedback on team cultures. Can Care Opinion help make care safer not just by telling clinicians about unsafe things that have been noticed, but by helping change the culture of teams in a way that supports safety?
Which part of your role do you find the most fulfilling?
The fact that Care Opinion is independent and non-profit means we can be creative, and I really enjoy having that freedom to innovate. I love the fast feedback loop we have with our contributors and subscribers as it helps us make the platform better every day. Our team is constantly coming up with ideas about how we can improve, and although we can’t do everything, we are often able to make changes quickly and try out new approaches.
On the other hand, our independence does have some disadvantages. As we have no statutory funding, we don’t have much financial security and have to be careful with our resources. Also, we don’t have any power to make changes within the healthcare system; our influence comes through a series of small nudges.
What patient safety challenges do you see at the moment?
The biggest challenge at the moment is around staffing levels and workload, which is causing huge stress for healthcare staff. Also, we’re living in stressful times as a nation for all kinds of reasons, and therefore patients are coming into healthcare with a lot of stress, often in crisis. They may have had very long waiting times, their care may have been uninterrupted by the pandemic, they may have been waiting for a test or scan for ages or they may not be receiving the right follow up. That makes care more difficult and emotional for everyone, and in that context it’s much harder to provide safe care.
It’s not just because of the overload of tasks, it’s also a relational issue. When we’re stressed, we don’t communicate as well with one another, we don’t trust each other as much and it’s harder to spend time listening to people. All of those factors make care less safe.
What do you think the next few years hold for patient safety?
Over the next few years, I hope we’ll see an increasing understanding of how different kinds of culture affect the safety and quality of care and how we can influence that in positive ways. I think at the moment everyone feels the importance of culture intuitively, but we don’t spend enough time researching and analysing it. There are different aspects to look at—some of it is about leadership and some is more about individual behaviours such as bullying.
One of the things I’m excited about with Care Opinion is the role of patients in helping to shift culture. Patients want to help - that’s why they give feedback! They want to improve things for themselves and other patients, they want to support staff and they want the culture to be more open to feedback and less defensive. Our understanding of these areas is increasing all the time and I’m hoping we’ll see opportunities for patients to make interventions individually or collectively that really do help improve the culture.
I mentioned earlier that the majority of feedback posted on Care Opinion is positive, and I think that’s because patients are trying to encourage and support staff. Actually, their encouragement and support is working, because we know that positive feedback from patients improves staff morale, confidence, pride, workplace relationships and even home relationships. All of those good things follow from what patients are sharing so it would be lovely to see that area of understanding develop.
If you could change one thing in the healthcare system right now to improve patient safety, what would it be?
My priority would be reducing staff vacancies, particularly in the nursing workforce. If we could fill the staffing gaps across the healthcare service we would improve patient safety quite quickly. But of course, that would need a magic wand to achieve!
Can you tell us something about yourself that might surprise us?
Some years ago I found myself at an event in Buckingham Palace, so I took the opportunity to explain Care Opinion to the Queen. She was very gracious and interested, and seemed very up on the challenges of web application development, which was rather surprising!