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As consumers take to the internet to rate their health care experiences, some doctors and hospitals are cringing. A few have even retaliated with lawsuits against patients who post negative comments about them. In Cleveland, for example, a physician sued a former patient for defamation after she complained online about her nose job.

Many health professionals are unnerved by the idea that patients are talking about them on Facebook, Yelp, Angie’s List, and other websites. With no structure or oversight, there’s a Wild West quality to it.

But instead of fearing and reacting defensively to what patients say about them online, what if doctors and hospitals took online comments as an opportunity to have a conversation about improving their services? It would require having an open mind, a willingness to change and — perhaps most of all — some courage.


Care Opinion, an independent, nonprofit, online platform that lets people in the United Kingdom share their health care experiences in ways that support learning and change, is leading the way. It has created a system for sharing and following the progress of these conversations that ensures both accountability and civility.

Take, for example, George, a patient at Robert Jones and Agnes Hunt Orthopaedic Hospital. He was frustrated after waiting more than two hours for an outpatient appointment. During that time, no one apprised him of what was going on or when he could expect to be seen. He decided to write about his experience on Care Opinion.


The hospital’s reply, also posted on Care Opinion, included an apology for the delay and a solution: large screens strategically placed in waiting areas that let patients see how much longer they have to wait.

George came away from the experience satisfied. “I believe in Care Opinion because what I want is real interaction and that’s what you get,” he wrote. “For me it is a better option than a formal complaint.”

At a hospital in Leeds, patient stories posted on Care Opinion uncovered a need for the mental health services clinic to expand its after-hours care. “Having that direct contact with people who tell their story provides a lot of detail that otherwise would not be understood,” wrote Guy Brookes, associate medical director at the clinic. “It becomes a constructive and collaborative process.”

In the United States, more than 100 large health systems voluntarily collect and report online patient comments and reviews, typically of doctors. It isn’t clear, however, how many of them systematically use that information to improve their services. Comments about other aspects of patients’ experiences — parking, costs, receptionists, nursing, billing, getting lost, and the like — though potentially useful, aren’t usually posted.

The result is that many health systems are missing an opportunity to learn from constructive insights that only patients can provide.

Rush University Medical Center in Chicago, where I work, was among the first health systems to publicly share patient ratings and comments on its website. We publish 98.5 percent of comments. (We don’t publish those that use profanity or other inappropriate language or contain comments that our legal department deems potentially libelous.) Our providers see all comments made about them before they are posted.

Since establishing this process, the hospital’s overall outpatient survey scores related to the quality of provider communication have increased significantly.

Although Rush goes a bit further than most, posting comments is not the same as having a dialogue with patients when they talk about their health care experiences online. What’s most different about Care Opinion is that, while it allows patients to tell their stories, it also allows doctors and other health care professionals to listen, gain insight, respond, and act. An independent study of Care Opinion funded by the Robert Wood Johnson Foundation concluded that pursuing its “six game-changing ideas can help health care systems in the United States better leverage patient narrative to transform their organizational culture and operations so that patients are truly at the center of care.”

On the Care Opinion site:

  • Everyone involved in a patient’s care (family member, caregiver, hospital staff, etc.) is encouraged to provide feedback.
  • Health care staff can see comments and feedback in close to real time — and reply to patients online.
  • The public can follow the story online and see how responsive the hospital or doctor is and whether they make any changes.

The key here is transparency: the ability for health care professionals to respond to patients’ comments and for the public to see those responses and any corresponding changes.

There’s no reason why hospitals and health systems in the United States couldn’t follow suit. It would take some work. For example, they would need to do a better job of soliciting patient feedback by asking deeper questions that produce more complete, balanced, and actionable responses.

Fundamentally, though, they would have to accept the risk of exposing themselves to uncensored public comments — positive and negative — and being held accountable for how they respond.

It’s an unnerving prospect. But it’s also a risk that hospitals and health systems should take. Listening to what patients say in their own words can be a powerful force for improving health care. In the end, everyone feels better.

Francis A. Fullam is assistant professor of health systems management at Rush University Medical Center in Chicago.