The importance of feedback
MSF, as an organisation, does not have a tradition of looking at patient perspectives as part of assessing our work.
There are tools we do use, such as exit interviews, but the focus in these is more to do with checking whether staff have done their job appropriately rather than asking how patients feel.
One of the standard tools asks, for instance, whether the patient understood how to take the medicine appropriately. Others ask if a patient has been taught things, but not about what they have understood.
A well-known cartoon showing the difference between teaching and learning.
Different tools are useful in different settings, however, most MSF projects are not a non-communicable disease programme working with refugees in Jordan – so they may not always be appropriate.
The standard exit interviews have never provided feedback for members of staff, but this is one of the best ways to improve performance and therefore help more people.
Changes take teamwork
It has taken a while for the idea of having a patient satisfaction process in our project to be shared, and then reviewed, and then for me to make more detailed proposals… and then to get things up and running.
I’ve been very much supported to make this happen, in particular by my colleague Abdullah who was appointed as a referral and quality improvement nurse a few months ago. He has done most of the legwork by interviewing patients (and most of the data entry, too!).
Although most of us never come across epidemiologists in our everyday lives, they are experts in creating surveys and analysing the results, and I was lucky to have two working part-time on our project. They helped me by challenging the details, concepts and approaches that I suggested, as did my medical coordinator, so that our new assessment is appropriately designed (“KISS” is a great bit of advice: Keep It Short and Simple).
In late February, the first surveys started in our clinics and we have carried out a few (about 10-12) every week since.
We deliberately kept it simple to start with, to find out what the overall feelings were about our receptionists, nurses, doctors, pharmacists and health promoters. Patients scored each question from “1 = Very poor” through to “5 = Excellent”, and, we now have some results.
Example of results from the patient survey work in Jordan. Credit: Mike Tomson
The feedback on the programme has been generally positive across every part of the patients’ experience. There are some areas that are not quite as wonderful as others, although some of these experiences can be explained by having temporary staff covering roles.
The most negative feedback was from a question about how hard it was to get to the clinic, however, more typically patients used the survey to feedback on our doctors.
A blog is not a place to provide all the results of a survey but if anybody wants more information please make a comment and I’ll get back to you.
I have now been able to share the great results to our staff and to publicly celebrate what is a real commendation of their hard work.
The next phase
We have now started the next phase with an amended questionnaire which asks much more detailed questions. This is to help us explore whether there are any areas of our staff training that we need to address or significant differences between personal approaches by individual doctors or nurses.
All of this is only possible because we have a relatively stable base of Jordanian staff who work in our clinics (many of whom have been here since almost the start of the programme). So, providing this feedback is a good investment in helping them and in turn helping the refugees and vulnerable people the programme is here for.
Our patients generally have little choice about coming to us as we are the only place in about 10 miles for them to get free care for non-communicable diseases. However, we have now shown that we can listen to their concerns and treat them with respect.