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What do you think of it so far?

Reflecting on why and how we ask people for their opinions on services, Les Bright draws on his personal and professional experience to suggest that we are likely to learn more by asking for opinions, not answers.

Many of us invite people using our services to comment on their experiences, regardless of whether a regulator requires us to do so. But few are so bold as to invite an outsider to conduct the work. Information gathered in this way can often be revealing, insightful and more credible than presenting some unsurprising facts from routine in-house surveys conducted by our own staff.

Learning from other trades

Every time I take my car to the garage for a service I get called a few days later by someone enquiring about my ‘customer experience’. They ask me the same old questions every time, ‘Was the member of staff who dealt with you polite? Did s/he explain the work that had been done? On a scale of 1 to 5, where 5 is the highest/best and 1 is the worst/least acceptable, how did we do…?’

I’ve never been asked whether I considered the service to be good value for the money spent, and I always try to introduce that into the call. The interviewer makes it clear, courteously, that what matters to me is of no interest to them, or, perhaps more pertinently, to the company on whose behalf they are asking me to comment.

After a recent visit for an annual service and MoT, rearranged twice at their request, I turned up an hour after the time I had been told my car would be ready for collection only to be informed that it would be another half hour. I accepted this, while making it clear that I expected the agreed price to be reduced as a result of their failure to complete the job within a reasonable time.

Once again I was called within 48 hours, but instead of wading through the predictable set of questions and then asking whether they would like my opinion on other matters, I asked at the outset if any of the ‘survey’ would cover value for money or price. I volunteered the view that, on the basis of my most recent visit, I appreciated their flexibility around price, only to be told that there was no space for this on the schedule of questions, and in any event I had opted out of giving my views by not agreeing to answer their standard questions.

I suppose I ought to be pleased that they persist in calling me every time, but so long as they continue to ask me about the things that matter to them and ask for my scores, the term ‘customer experience’ seems to be a misnomer, or just a case of going through the motions. And, on this occasion, they missed out on the chance of some unsolicited positive feedback from which they could have learned.

The healthy approach                  

Now, as well as being someone with a long career in social care, managing services, acting as an advocate, researching and campaigning, I am also the son of a 94 year old lady who moved into a care home a few months ago after around five weeks in hospital.

The hospital displayed graphs depicting the ward’s performance, as measured by patients’ families’ comments, and piles of questionnaires were strategically placed around the public areas. But nobody ever asked me for my opinion nor, more importantly, was able to answer my simple questions, ‘…I don’t really know, I think you’ll have to ask someone who was on duty earlier…’ However, as these people were on duty earlier, they tended not to be around when I visited.

I was pleased to be consulted about the plans for Mum to be transferred to the care home we had chosen, with an ambulance arranged for 2pm the next day, suiting the home, the hospital and me. However, the next morning at around 10.30am, as I was driving to the home with bits and pieces to personalise her room, I was called by the manager to check when I would be arriving, as Mum had just been delivered there by patient transport. At this point I wondered where I might find a copy of the questionnaire asking me ‘How are we doing?’. However, I put this to the back of my mind as I focused on ensuring the smoothest possible transition for Mum.

What do residents and relatives think?

This leads me to ask, can care providers learn from a garage or a hospital ward in their attempts to uncover meaningful feedback from residents and their families?

Care homes are built on multiple relationships of varying degrees of intimacy, offering differing perspectives on how well the home is doing in providing a fulfilling life, appropriate care and a personal service to people being looked after there.

Capturing the opinions of all parties may be too demanding, require elaborate systems, take staff away from other tasks and may not deliver the hoped-for insights. It is, therefore, crucial to prioritise listening to, and learning about, concerns of residents and their families, to record these as accurately as possible and to demonstrate, wherever necessary, that you have heard and acted on the comments made.

Experience of casually asking residents their opinion on the home they live in is that many will frequently offer feedback such as ‘…all the girls are wonderful…’ or ‘…mustn’t grumble…’ or ‘…the food is very good…’ – good to hear, but not very illuminating or helpful in adjusting staff practices. While there may be a wider range of opinions offered by residents’ families, such comments may not be absorbed into a wider look at how the home is doing.

Uncovering secrets

However, if it is possible, set aside time to listen. By using a schedule of prompts that starts from the premise that what matters to the resident or their closest family matters to you, you will learn things you didn’t already know. You may spot patterns that lead you to reconsider how you organise tasks or routines. I have followed this approach in almost 20 homes where the registered owners have decided that the best bet for securing more, different and fuller information on what people think is to ask an outsider to come in to meet residents and relatives.

I’ve always come away thinking that this approach uncovers new and different perspectives on what works – and why, and what doesn’t work – and what might be done to improve the situation, although I suppose I’m bound to say that! The ‘secrets’ uncovered in this way include incredibly heartening stories of staff ‘going the extra mile’, as well as people being relieved at finding a way of relating something that worries them, but not sufficiently to risk damaging established relationships with staff or other residents.

People are often surprised when I open our conversation – it’s not an interview – by telling them that I do not have a questionnaire that I am working my way through, and that I will not be ticking a series of boxes, adding up the scores and declaring the home to be good, bad or indifferent. I invariably tell them that nothing is ‘out of bounds’ and that I am interested in hearing what matters to them. I tell them that there are topics or areas of interest that I hope we will cover, but their issues take precedence over mine. I make no unsustainable claims – that problems will be solved, or the need for agency staff will disappear, or fees will be reduced. I also make sure that they appreciate that, although I am not an employee of the organisation running the home, I am nevertheless working for them and will be reporting back my findings.

Generally, I spend up to an hour with each person I meet so that, in a day, I will meet a minority of residents, but what the approach lacks in numbers is more than made up for by the in-depth reporting of conversations and the concerns – and compliments – which people express.

In common with other similar encounters people may casually throw out a comment of great significance with the words ‘…it’s only a little thing...’, to which I invariably respond by telling them that nothing is too small to be considered, and that ‘small things make a big difference’ when it comes to offering a personal service.

Committing to feedback

Collecting people’s opinions and experiences, and then producing a report, is only useful if the organisation owns the activity to the extent of committing to feed back the findings to residents and relatives. This is critical to my belief that I am doing something worthwhile.

Some relatives use talking to an independent person as a therapeutic activity. They can work through their feelings of loss and disappointment at no longer being able to care for a loved one in a domestic setting and express worries ‘safely’, that is, without compromising their relationship with managers, carers or other members of their family.

The risks of possibly learning things that cause concern is far outweighed by the confidence that the process can convey to those who choose to share their opinions. Indeed, those who don’t choose to speak usually welcome the fact that the provider is prepared to engage the services of an outsider to comment on service quality, as a result of listening to other lay-people.

Les Bright is an Independent Consultant at BCD Care Consultants.

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