Dorothy Armstrong's thoughts on apology generated a real buzz at our recent Glasgow event.  We're delighted that she's agreed to write this blog.

‘We are all human – we can all make mistakes.’

This quote is from a man whose son died. He brought his complaint to the Ombudsman, he said, to ensure that he was listened to, lessons were learned and to receive an apology.

In my role as Professional Adviser to the Scottish Public Services Ombudsman (SPSO), I hear first hand from patients, relatives and carers about negative experiences of healthcare. The most common emotion expressed is of vulnerability, helplessness and humiliation.

When I read the stories shared on Patient Opinion, the themes are very similar to our experience at the SPSO. We see poor communication, behaviour and attitude as the most significant factors in the complaints we receive. In many cases, people feel that they have not been listened to. They feel patronised and powerless. If only staff involved in a mistake or wrong doing, had been honest and open and provided an apology at the time, they would not have continued to complain.

‘An apology is the superglue of life. It can repair just about anything.’ 

New South Wales Ombudsman, (2009).

As children, we are programmed to say sorry for our mistakes, but, in our working lives as adults, saying sorry is a real challenge. When used well in the NHS setting, an apology can be both very powerful for the patient and empowering for staff.

Sorry made easy - The 3 R’s

You can use this tool at work and at home. I’ve found it particularly effective with my teenage children – take a deep breath and try it too!

Regret

It is important to recognise that something has gone wrong by acknowledging the wrong doing, even if you are not at fault. Saying sorry, in a meaningful and sincere manner, is crucial. Often this first step is enough to de-escalate the situation.

Reason

Even if you feel criticised and hurt, it’s really important to provide a reason (if there is one) for the mistake, but to avoid being defensive. Make sure you are clear that the wrong doing was not intentional or personal, so try to keep to the facts. It can help to put yourself in the complainant’s shoes and step back from the situation. Stay objective.

Remedy

Try to resolve the mistake there and then, if you can. Ask the complainant what they would like to happen and take responsibility to investigate, if required, and to provide feedback to them as soon as is practicable. Encourage colleagues to be proactive too.

Dr Dorothy Armstrong is Professional Adviser to the Scottish Public Services Ombudsman.

The SPSO’s Guidance on Apology sets out what an apology is and what you can do to make it meaningful.

Dean Fathers really made me think the other day. Not only is Dean Chair of Nottinghamshire Healthcare Trust and Visiting Professor at Cass Business School, he also comes from a non-NHS background and always has interesting things to say. He pointed out that the NHS was very good at sprinting and being pace setters: Cometh a new initiative, cometh the 'pilots' and 'pathfinders' and 'beacons' keen to show they are doing the business. And they often do really great work. But as Dean said, real change is about much more than sprinting, necessary as that sometimes is. More like being a marathon runner - a long, enduring, race that can still be fun and is certainly full of achievement but is never over quickly.

The gains from being a sprinter often have little to do with the core activity being promoted and much more about glitz, and kudos and brownie points. Sweet stuff, easily swallowed, done in a minute. Like all confections people can quickly feel sick, dissatisfied, as if nothing of much nutritional value has been consumed. And since change does take time, sprinters often give up long before there is much real change to show for their efforts.

I guess right now that lots of people across the NHS feel like marathon runners in a compulsory, never-ending race of Move the Deckchairs. But even though this reform-driven turmoil may feel particularly pointless, at Patient Opinion we recognise the truth of Dean' remarks. If we want to really get somewhere different with patient engagement then its going to take time. As it happens Dean's own trust, Nottinghamshire Healthcare Trust is one of the most extensive users of Patient Opinion (and happy to talk to people interested in what they have learnt). This too did not happen overnight. But 2 years in they now have 124 people on the system and have made 36 changes as a result of feedback.

So if it feels like a marathon don’t give up. Here at Patient Opinion it can certainly feel like that. After all it's 7 years since I founded Patient Opinion which in my book definitely isn't a sprint. We've achieved a lot, much of it with your help. But there's still a lot to do. So just pass the water bottle, keep going and wait for the endorphins to kick in. We'll get there in the end.

I recently had the privilege of being in a teleconference with Mike Alverson, the CEO of Kaiser Permenante, one of the biggest integrated providers of health care in the States.

One of the interesting things he said was that Kaiser now divided health care into 4 settings:

• - Staffed beds. This includes hospitals and residential settings
• - Ambulatory care by which they mean clinics, out patients, pharmacies etc
• - Domiciliary settings where the patient is looked after in their own beds
• - The web – email and skype consultations, telemedicine, appointment booking, shared decision making and other information aids and your own personal EPR

This made me stop for lots of reasons. Of course! The web *is* a major setting for health care. And one that is rapidly evolving and effecting the other three. And - just like PO - the web is an intrinsically egalitarian place to do health business.

All this is not just happening in California where Kaiser is based. Whether it is giving feedback about what happened to you via Patient Opinion, booking your own appointment on Choose and Book, using your own EPR via Patients Know Best, or exploring patient-founded sites like MoodScope, the web is already becoming a major place for patients across the UK.

I began at Patient Opinion in February. My first morning was a textbook fail as I battled through the snow, geared with boots and a good number of layers, only to find myself a good mile away from the office – thanks to terrible misguidance from my phone. So, I started my first day an hour late, and more than a little animated.

Despite my tricky start I settled in pretty much straight away and cracked on as my boots began to dry. This isn’t to say that I wasn’t a little sceptical with the whole idea to begin with. Patient feedback on the web – my first thoughts were surveys and does this actually work, do people really comment and share their stories? I soon learnt that they do.

I was quickly shown the ropes and got to know how it works and was relieved to find out I wouldn’t be trawling through survey data. As a trainee journalist (or professional nosey parker as my mum likes to refer to me as), my key interest is in people and particularly in current affairs and our health services. With a fair share of time spent in hospitals growing up with a family with aliments stretching the length of the Magna Carta, it wasn’t hard to develop an interest in them and how they are ran and more importantly to me how they can be improved.

A lot of my internship has been based around the social networking side of the site and how people now communicate. It’s great yet slightly overwhelming how many different ways people can now interact with one another and share their opinions. Twitter, Blogging, Facebook, YouTube – everyone has their own piece of internet real estate and when used well, you can really reap the rewards, as I have seen here at Patient Opinion.

Over the last couple of months I have had the privilege of working with an organisation I have grown a developed interest in and truly admire. I think it is really important to voice our opinions and not only say when something is wrong but when something is done well too. Working here has been great as I’ve been at the heart of it all, hearing the stories come in and reading about the changes health services have made in numerous cases to accommodate their service users.

Aside from adapting to the alien thought of waking up at a time I never knew existed and enduring a 9-5 working day, I have also developed a clearer understanding of how a team works and an organisation develops. What I enjoyed the most was finding out what the public really think of our health services and speaking to them face to face.

I thoroughly enjoyed speaking with students last week and asking them about their experiences of health services. I loved putting the piece together and helping alongside the social media side of the organisation has been great too. I will take away with me from this experience a greater understanding of how to utilise the tools we have, specifically social media, to our advantage. I have also learnt how to adapt to different writing styles for a variety of audiences and across different platforms – something particularly useful with the career I’m heading towards.

I will miss everyone at Patient Opinion, but will keep in touch. I wish everyone all the best in the future and I hope my journey home this afternoon is a little easier than my first journey here…

For many people the NHS is like marmite, but whether we love it or hate it, we all end up using it one day, one way or another.

Students are one of the most outspoken, actionable social groups around, so when asking a number of them for their opinions on health services – an outspoken answer was what I got.

It has been an interesting few days hearing student’s thoughts on their health services. Below is a film the students I met, sharing their views – but not everyone was happy to be filmed, and as you’ll read below, there were quite a range of views!

International students, on the whole told me that they thought the NHS was great. When asked why, they mostly replied, ‘because it is free and available to all’. Interesting, a majority of the international students I spoke to also felt open minded to the idea of reforms and privatisation of the NHS.

In comparison, British students were a little more sceptical. But, overall they also agreed that the NHS was a great thing, although they did say that there are improvements to be made – all of which can be done with the help of patient feedback.

Elizabeth Etheridge who is studying French at the University of Sheffield, told me how her Nan had recently been in hospital but she felt the only reason ‘things were being done quickly’ was because her mum ‘knew the right people and could pull a few strings’. However, when speaking of the University health service, she could not speak highly enough, ‘fantastically well run, great service and really pleasant doctors.’

Interestingly, when I asked her about her thoughts on Patient Opinion, she said, ‘I’ve never heard of it but I think it’s a great idea. Change always starts from the bottom.’

One group of students I have been eager to speak to are medical students. Fortunately, I did manage to speak to a few outside the University Information Commons on Wednesday.

Although they didn’t wish to be filmed or be directly quoted, they did speak to me and pass on some really intriguing information. One male student who was in his fourth year of medicine told me of how he was intending to leave the field before he had even started because of ‘all of the bureaucracy’. His course mate told me she would be sticking with it but was sceptical of her future as she said, ‘the NHS isn’t what it used to be’. She also told me how all the medical students she knew were in uproar over the current proposed changes.

Speaking with students about their experiences of health services and their thoughts on the NHS, has made me see that students do care about their services and would like to see change. What is more important I think now, is that a site such as Patient Opinion try and expand its reach to students. Students are the next generation and with their strong political ideologies and desire for change, their work and interaction with PO could be surprisingly influential.