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What does patient feedback reveal about the NHS? A mixed methods study of comments posted to the NHS Choices online service
  1. Gavin Brookes1,
  2. Paul Baker2
  1. 1 School of English, University of Nottingham, Nottingham, UK
  2. 2 Department of Linguistics and English Language, Lancaster University, Lancaster, UK
  1. Correspondence to Dr Gavin Brookes; gavin.brookes{at}


Objective To examine the key themes of positive and negative feedback in patients’ online feedback on NHS (National Health Service) services in England and to understand the specific issues within these themes and how they drive positive and negative evaluation.

Design Computer-assisted quantitative and qualitative studies of 228 113 comments (28 971 142 words) of online feedback posted to the NHS Choices website. Comments containing the most frequent positive and negative evaluative words are qualitatively examined to determine the key drivers of positive and negative feedback.

Participants Contributors posting comments about the NHS between March 2013 and September 2015.

Results Overall, NHS services were evaluated positively approximately three times more often than negatively. The four key areas of focus were: treatment, communication, interpersonal skills and system/organisation. Treatment exhibited the highest proportion of positive evaluative comments (87%), followed by communication (77%), interpersonal skills (44%) and, finally, system/organisation (41%). Qualitative analysis revealed that reference to staff interpersonal skills featured prominently, even in comments relating to treatment and system/organisational issues. Positive feedback was elicited in cases of staff being caring, compassionate and knowing patients’’ names, while rudeness, apathy and not listening were frequent drivers of negative feedback.

Conclusions Although technical competence constitutes an undoubtedly fundamental aspect of healthcare provision, staff members were much more likely to be evaluated both positively and negatively according to their interpersonal skills. Therefore, the findings reported in this study highlight the salience of such ‘soft’ skills to patients and emphasise the need for these to be focused upon and developed in staff training programmes, as well as ensuring that decisions around NHS funding do not result in demotivated and rushed staff. The findings also reveal a significant overlap between the four key themes in the ways that care is evaluated by patients.

  • Patient feedback
  • NHS Choices
  • Quantitative linguistics

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  • Contributors GB co-planned and co-conducted the research, and took charge of writing the paper. He is responsible for the content as guarantor. PB co-planned and co-conducted the research and contributed to the writing of the paper. Both authors had access to the data.

  • Funding Economic and Social Research Council; grant number: ES/K002155/1.

  • Disclaimer All authors have completed the ICMJE uniform disclosure form and declare: all authors had financial support from the Economic and Social Research Council for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Competing interests None declared.

  • Ethics approval Research ethics approval for the study was obtained from Lancaster University, Lancaster, UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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