gms | German Medical Science

15. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

5. - 7. Oktober 2016, Berlin

Through patient's eyes. Individual Clinician Feedback (ICF)

Meeting Abstract

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  • Bridget Hopwood - Picker Institute Europe, Health Experiences, Oxford, United Kingdom
  • Sarah-Ann Burger - Picker Institute Europe, Health Experiences, Oxford, United Kingdom

15. Deutscher Kongress für Versorgungsforschung. Berlin, 05.-07.10.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocV015

doi: 10.3205/16dkvf083, urn:nbn:de:0183-16dkvf0839

Published: September 28, 2016

© 2016 Hopwood et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Development of the Individual Clinician Feedback tool in England 2012/13

Background: When people are ill they want excellent clinical practice provided in a safe environment by doctors who show they care for them. Where patient experience data is collected it does not usually drill down to particular clinical teams or individual clinicians where it matters most to patients. Collecting feedback on Individual clinicians enables you to understand and improve patient experience of specific doctors. It also allows you to enable personal development and improvement; facilitate patient choice and to use results for revalidation.

Aim: To develop and test a tool for collecting individual consultant feedback from patients that is robust, sustainable and fit for purpose, and to explore methods of data collection in order to understand each one’s efficacy, validity, logistical ease.

GMC’s Good medical practice: The General Medical Council (GMC) is the independent regulator for doctors in the UK. The GMC publish advice to doctors on the standards expected of them. All doctors must be familiar with and follow Good medical practice and the explanatory guidance. The Picker Institute Individual Clinician Feedback tool was developed in 2012 to measure a doctor’s performance against these standards, drawing on elements of communication skills and behaviours to give an indication of performance.

Method: The ICF questionnaire development process included: Literature review; interviews with 14 patients with a range of conditions; review of reasons for complaints to identify aspects of problematic practice; cognitive testing of draft questionnaire with patients to for comprehension and relevance; extensive piloting in a range of settings with a variety of patients.

Pilots: Three pilots of the questionnaire were undertaken, two in acute settings and a pilot in eight GP practices. Phase 1 of the pilot saw the ICF instrument initially trialled in a Urology outpatient setting - it offered 4 different methods of providing feedback to patients after their outpatient appointment.

GP Pilot: The tool was then piloted in Primary Care with eight GP practices (76 GPs) using a mixed paper methodology (handout and postal). A total of 6,652 patients were invited to participate of which 2,767 completed questionnaires were returned, a response rate of 43.2%. The handout method had a higher response rate than the postal method in all practices, most likely because the questionnaire is given at the end of the appointment and the consultation is fresh in the patient’s mind. Arguably, patients being given the questionnaire by the doctor (rather than a third party) may also boost response rates. However, it also produces potential response bias which can be of a complex nature but often inflates scores on quality related questionnaires.

Acute Pilot: Further pilots took place in acute settings – in Medicine (9 consultants) and Orthopaedics (16 consultants); and with 23 consultants (13 Cardiology and 10 Cardiac Surgery). One hospital trust published the individual consultants’ results on their website along with their clinical data.

With each pilot study, the data were subjected to extensive analysis to examine feasibility of different modes of administration; response rates; doctor-level reliability; internal consistency reliability; patient, doctor and contextual factors that introduce systematic bias; the development of methods and thresholds for benchmarking.

Conclusions: The three pilots that took place showed that:

  • The tool is able to obtain a statistically robust measurement of what we originally set out to measure – ie a consultant’s or GP’s communication skills as mapped against the GMC good practice guidance and as evidenced by the experience of patients.
  • Statistical evaluation of the tool indicated a very high reliability at patient level.
  • The tool works in a variety of clinical settings and we are confident that it will translate to most settings, with the exception of A&E and Psychiatry. It will however, need to be carefully adapted, piloted and validated for use with different service user groups (for example children and young people and those with learning disabilities).

Data can be collected using several different methodologies although the postal methodology is the only way of assuring that there is no bias or ‘cherry picking’ of respondents. Gaining accurate records of patient details for the postal methodology still presents a challenge which needs to be overcome in a cost effective way for trusts to take this on board.

Discussion: The existing tool, whilst relevant as an improvement tool to feed into appraisal and development, does not currently measure overall fitness to practice in its’ current state. The feedback should be seen as part of a package used to come to an overall judgement. We don’t currently have a colleague assessment tool so can’t provide 360 feedback as yet. But can a colleague accurately comment on patient-doctor communication skills unless they are in consultations with them?

Contributed equally: B. Hopwood, S.-A. Burger