Caring for Care: Online Feedback in the Context of Public Healthcare Services

F. Mazanderani; Susan Kirkpatrick; S. Ziebland; Louise Locock; J. Powell

doi:10.1016/j.socscimed.2021.114280

Caring for Care: Online Feedback in the Context of Public Healthcare Services

F. Mazanderani ^* (Corresponding Author), Susan Kirkpatrick, S. Ziebland, Louise Locock, J. Powell

^*Corresponding author for this work

Health Services Research Unit (HSRU)

Research output: Contribution to journal › Article › peer-review

16 Citations (Scopus)

4 Downloads (Pure)

Abstract

People increasingly provide feedback about healthcare services online. These practices have been lauded for enhancing patient power, choice and control, encouraging greater transparency and accountability, and contributing to healthcare service improvement. Online feedback has also been critiqued for being unrepresentative, spreading inaccurate information, undermining care relations, and jeopardising professional autonomy. Through a thematic analysis of 37 qualitative interviews, this paper explores the relationship between online feedback and care improvement as articulated by healthcare service users (patients and family members) who provided feedback across different online platforms and social media in the UK. Online feedback was framed by interviewees as, ideally, a public and, in many cases, anonymous ‘conversation’ between service users and healthcare providers. These ‘conversations’ were thought of not merely as bringing about tangible improvements to healthcare practices, but as in themselves constituting an improvement in care. Vital to this was the premise that providing feedback was an enactment of care – care for other patients, certainly, but also care for healthcare as such and even for healthcare professionals. Ultimately, feedback was understood as an enactment of care for the National Health Service (NHS), as symbolically encompassing all of the above. Putting these findings in dialogue with STS scholarship on care, we argue that, in this context, the provision of online feedback can be understood as a form of care that is, simultaneously, both directed at healthcare (in the round, including patients, professionals, services, organisations, and, of course, health itself) and part of healthcare. We conceptualise this as ‘caring for care’. This conceptualisation moves beyond dominant framings of online feedback in terms of ‘choice’ and ‘voice’. It embeds online feedback within pre-existing healthcare systems, relations and moral commitments, foregrounds the mutuality of care relations, and draws attention to the affective labour of feedback practices.

Original language	English
Article number	114280
Number of pages	8
Journal	Social Science & Medicine
Volume	285
Early online date	29 Jul 2021
DOIs	https://doi.org/10.1016/j.socscimed.2021.114280
Publication status	Published - 1 Sept 2021

Bibliographical note

ACKNOWLEDGEMENTS
The authors would like to thank all the research participants, without whom this work would not have been possible. They would also like to thank James Munro for his support and insights, and the entire INQUIRE team. This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Health Services and Delivery Research Programme (Grant Reference Number 14/04/48). JP also receives funding from the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust. The views expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health.

Keywords

UK
NHS
Digital technologies
Care
Feedback
Ratings
Reviews
qualitative
interviews

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© 2021. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/
Accepted author manuscript, 2.73 MBLicence: CC BY-NC-ND

Cite this

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abstract = "People increasingly provide feedback about healthcare services online. These practices have been lauded for enhancing patient power, choice and control, encouraging greater transparency and accountability, and contributing to healthcare service improvement. Online feedback has also been critiqued for being unrepresentative, spreading inaccurate information, undermining care relations, and jeopardising professional autonomy. Through a thematic analysis of 37 qualitative interviews, this paper explores the relationship between online feedback and care improvement as articulated by healthcare service users (patients and family members) who provided feedback across different online platforms and social media in the UK. Online feedback was framed by interviewees as, ideally, a public and, in many cases, anonymous {\textquoteleft}conversation{\textquoteright} between service users and healthcare providers. These {\textquoteleft}conversations{\textquoteright} were thought of not merely as bringing about tangible improvements to healthcare practices, but as in themselves constituting an improvement in care. Vital to this was the premise that providing feedback was an enactment of care – care for other patients, certainly, but also care for healthcare as such and even for healthcare professionals. Ultimately, feedback was understood as an enactment of care for the National Health Service (NHS), as symbolically encompassing all of the above. Putting these findings in dialogue with STS scholarship on care, we argue that, in this context, the provision of online feedback can be understood as a form of care that is, simultaneously, both directed at healthcare (in the round, including patients, professionals, services, organisations, and, of course, health itself) and part of healthcare. We conceptualise this as {\textquoteleft}caring for care{\textquoteright}. This conceptualisation moves beyond dominant framings of online feedback in terms of {\textquoteleft}choice{\textquoteright} and {\textquoteleft}voice{\textquoteright}. It embeds online feedback within pre-existing healthcare systems, relations and moral commitments, foregrounds the mutuality of care relations, and draws attention to the affective labour of feedback practices. ",

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author = "F. Mazanderani and Susan Kirkpatrick and S. Ziebland and Louise Locock and J. Powell",

note = "ACKNOWLEDGEMENTS The authors would like to thank all the research participants, without whom this work would not have been possible. They would also like to thank James Munro for his support and insights, and the entire INQUIRE team. This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Health Services and Delivery Research Programme (Grant Reference Number 14/04/48). JP also receives funding from the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust. The views expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health. ",

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N1 - ACKNOWLEDGEMENTS The authors would like to thank all the research participants, without whom this work would not have been possible. They would also like to thank James Munro for his support and insights, and the entire INQUIRE team. This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Health Services and Delivery Research Programme (Grant Reference Number 14/04/48). JP also receives funding from the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust. The views expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health.

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KW - NHS

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KW - Feedback

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VL - 285

JO - Social Science & Medicine

JF - Social Science & Medicine

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ER -

Caring for Care: Online Feedback in the Context of Public Healthcare Services

Abstract

Bibliographical note

Keywords

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