Anyone who has taken a trip, eaten out or shopped for consumer goods in the past few years is well acquainted with the ubiquitous user review.
Rarely do we make a purchase these days without consulting websites like TripAdvisor or Yelp, but increasingly, a similar five-star rating system is being applied online to health care — both to rank doctors and hospitals.
In a first for Canada, CBC's the fifth estate has launched an interactive tool that allows patients to rate the quality of care in their own hospitals. It's part of Rate My Hospital, an in-depth look at hospital performance across the country.
Websites like RateMDs.com, DrScore.com, and Vitals.com in the United States, RateMyHospital in Ireland and others have been around for years.
Most are run by commercial entities, non-profit organizations, patients groups or professional associations, but in 2008, the U.K. government entered the fray with a TripAdvisor-style tool in hopes that user-generated hospital reviews would lead to better care.
CBC's online patient ratings tool allows users to evaluate their hospital stay using a five-star rating scale on five measures:
- Overall recommendation.
- Cleanliness of the hospital
- Communication with the staff.
- Courteous and respectful treatment.
- Timely care.
Existing hospital surveys lacking
In Canada, feedback about hospital care is currently collected primarily through patient complaints and patient satisfaction surveys sent out by hospitals to select patients after they are discharged.
Sholom Glouberman, president of the Patients Association of Canada, says conventional patient surveys don't capture the 'grit' of actual patient experiences. For that, you have to listen to patients' stories, he says. (Nathan Denette/Canadian Press) "They're not very interesting," said Sholom Glouberman, president of the Patients' Association of Canada. "All the satisfaction surveys are the same — they all say patients like doctors best, nurses second best and food worst."
Hospitals rarely make the results public, and little of the information appears to get used, says Glouberman.
"It's very hard to see what changes happen as a result of the feedback they get," he said.
Hospital ratings and feedback tools, says Glouberman, often fail to capture the "grit" of the patient experience that comes from hearing personal stories.
"When you start to get these stories, you start to understand some of the things that can be done to make things better," he said.
Ratings not 'just noise'
While online ratings may not capture the whole picture, some studies suggest they are good indicators of the quality of care at a particular institution.
"They aren't just noise," said Felix Greaves, an honorary clinical research fellow at Imperial College London's School of Public Health.
Greaves and his colleagues evaluated more than 10,000 hospital ratings posted over two years on NHS Choices, a website that allows users to rate hospitals and other heath care services in England.
The site is unique among health-care ratings websites in that it was created by the National Health Service, the government authority that runs England's public health system, and not a third party.
The researchers found that the ratings and comments posted to the site generally corresponded to patient outcomes in hospitals during the period studied.
"Better-rated hospitals had lower general death rates; they had lower readmission rates; and they had lower infections from both MRSA and C. difficile," Greaves said of his study's findings, which were published last year in the Archives of Internal Medicine.
Ratings matched clinical findings
Those facilities that rated poorly on cleanliness had higher infection rates, the study found.
Hospitals that patients wouldn't recommend to loved ones and facilities where they said they were not treated with respect and dignity had worse patient outcomes than those where the opposite was true.
Ratings for some hospitals in the London area appear on NHS Choices, a U.K. government-run website that allows users to evaluate hospitals in four areas and give an overall rating of one to five stars. Although the ratings represented a tiny fraction of the total number of patients treated, the results were revealing, said Greaves.
"We found that even with relatively small numbers, you actually start to see patterns that look a bit like patterns that we measure when we try to spot hospital quality from other points of view," he said.
The correlation between hospital ratings and patient safety indicators wasn't always perfect, Greaves said, but it showed that the information on such ratings websites can represent the realities on the ground and can be quite useful.
'Wisdom in the crowd'
Though physicians and hospital administrators generally dislike anonymous online surveys because of fears the reviews will skewer doctors and tarnish reputations, the U.K. study found that the bulk of comments on NHS Choices are positive. A separate study Greaves did found the responses corresponded to those given by patients in traditional surveys administered by hospitals.
The U.K. has been ahead of many other countries in evaluating hospitals and posting performance indicators online. Its efforts have been largely motivated by some high-profile scandals involving spectacular failures in hospital care.
If other jurisdictions want to catch health-care problems before they develop into scandals, Greaves said, they should pay closer attention to ratings sites like NHS Choices, which can help hospitals evaluate areas in need of improvement.
Feedback and ratings tools are only one part of a broader conversation about health care that patients are already having online, a conversation that also includes social media websites like Twitter and Facebook, blogs and discussion forums.
Hospitals must learn how to harness this feedback and use it to improve the quality of their care, said Greaves.
"It's not perfect, but there seems to be, at least to an extent, a wisdom in the crowd," Greaves said.
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