CFEP Reports and Development Consultant, Louise Coleman, has been working on a patient feedback tool for healthcare professionals to use for remote consultations for more than 12 months. The increased interest in the survey product swelled as the COVID-19 pandemic has changed the way GP practices and individual health professionals deliver their services. We recently interviewed Louise about her experience developing this new patient feedback innovation and preparing to launch this particular questionnaire at this particular time.
Q. Can you explain in a few sentences the overall goal with the development of the CFEP Remote Consultations Survey product for healthcare professionals?
A. We wanted to create a tool that could provide GP practices and individual health professionals with feedback from patients about their experience of telephone and/or video consultations specifically.
Many practices in the UK had already been using telephone triage and telephone consultations for a number of years and with the latest GP contract focusing on making online/video consultations available to all patients, we felt that it could be really beneficial to offer a survey that would provide specific feedback on the patient’s experience during their remote consultation.
We wanted to provide a tool that would focus on the health professional’s interpersonal skills within these remote consultations and provide wider feedback on the telehealth consultation system as a whole. Our goal is to support both individual clinicians and practices in determining where their system is working well and where improvements could be made.
Q. How did the idea to develop a survey gathering information on the patient experience in remote or ‘virtual’ consultations come about?
A. The idea grew from enquiries received from individual clinicians who were struggling to find a suitable patient feedback tool that would meet appraisal and revalidation requirements, because they had very limited or no face to face interactions with patients.
Previous work with the Primary Care Foundation regarding avoidable appointments in general practice had also shown us the importance of efficient systems to ensure that patients are directed to the right health professional or service. This insight, combined with telephone triage becoming more common in GP practices, led us to believe that a tool specific to remote consultations would provide valuable insight for both practices and individuals.
With this in mind, we sought to combine our CFEP Interpersonal Skills Survey with broader, system-based questions that would give vital feedback on the remote consultation process as a whole.
Q. This new patient feedback tool is based on the industry benchmark CFEP Interpersonal Skills Survey. What modifications were incorporated to create a product suitable for remote consultations?
A. The existing CFEP Interpersonal Skills Survey has been extensively validated and provides individual doctors, nurses and other health professionals with meaningful patient feedback that is suitable for meeting revalidation requirements and their continuing professional development. As such, we wanted to keep this element of the CFEP Remote Consultations Survey as true to the original CFEP Interpersonal Skills Survey as possible, with only very minor changes to some of the framing text, so that the integrity of the interpersonal skills questions was not compromised.
Fortunately, because CFEP’s patient feedback tool for individual practitioners does focus purely on the interpersonal skills during the consultation, it was already very versatile in terms of the types of consultations it could be used for and the breadth of different health professionals that it would work for.
What is different about this new questionnaire are the additional questions that will provide insight into the remote consultations service as a whole.
We were especially keen to help practitioners identify any gaps in the communication process that might come about as a result of the actual method and tools they’re using for the consultation; that is the telephone or video consultation. Built into the feedback process is the understanding that there are elements that could be less easily seen in remote consultations such as cues or flags that are more easily seen in a face to face consultation.
Also, by using the same questions as individual clinicians have used before in face to face consultations, any differences in the feedback from remote consultations will provide them with specific insight into those communication gaps.
We hope to support practitioners as they navigate this challenging new environment, helping minimise any potential risk and encouraging professional development.
Q. Can you tell us how the process of gathering and evaluating patient feedback on telephone and video consultations is different to standard face to face consultations?
A. With face to face consultations we usually recommend a paper based exit survey approach as the primary method of completion. However, if the consultation has taken place remotely, this method is not possible and any paper based survey becomes cumbersome and potentially costly.
As such, we will be providing an online completion method for this survey, which can be provided to patients via text or email (or even in person where this still applies as the result of a remote consultation). We offer an online completion option for a number of our patient surveys already, so the methodology is tried and tested, although this is the first survey that we aim to run exclusively online if possible. So we will be conducting analysis of trial data returned for this questionnaire against data from paper based completion to ascertain any potential differences that may need to be highlighted or investigated further before the questionnaire is finalised.
Q. Has finalising this particular product at this particular time had any personal impact, given the devastating effects of COVID-19 and its role in the fast-tracked rollout of remote consultation services?
A. It certainly feels more important now that we provide a useful and robust tool in this area, because so many more patients will be accessing primary healthcare in this way. The rollout of this tool has happened more quickly than I initially anticipated due to these changes in the sector.
CFEP was originally formed with the express intention of supporting clinicians to communicate and connect with patients and we take that responsibility seriously. In this case, it feels all the more important that we have a tool that can do that and deliver the feedback that people need.
Q. Rigour is the hallmark of CFEP survey products. What testing protocols are in place to ensure that this new product is both fit for purpose and supportive for practitioners and their patients?
A. We will be trialling the questionnaire in select practices and will work with that test data and on feedback from the practices. This will show us whether the questionnaire and survey process will require any further refinements.
All our standard protocols are in place to protect patients and practitioners. The guidelines we have for managing online surveys – including how we manage privacy and data for patients – are part of our standard robust practice. For example, the data will come directly from patients to our database ensuring patient anonymity.
We will also be tracking all feedback to determine if there are any differences as a result of the online response mechanism that may impact results.
The most important thing for CFEP will be to ensure that clinicians are supported throughout the process and provided with meaningful results to reflect on.
Initially we had thought that the new Remote Consultations Survey would be most useful in General Practice, where the use of telephone triage and video consultations was becoming more prevalent well before the pandemic hit.
However, the universal changes to healthcare delivery that have come about as a result of COVID-19 have definitely created a need for this kind of product in other settings.
As such, we have already developed a version of the Remote Consultation Survey that is better suited to secondary care settings and this is currently being trialed by a number of hospital doctors.
This next iteration of the survey will be suitable for doctors and other healthcare professionals across a range of hospital and community settings. By adapting the survey in this way, we hope to provide a wider variety of practitioners with a survey tool that can yield meaningful feedback for reflection on what, for many, will be an entirely new way of practicing.