Ireland has this year been rocked by the publication of a shocking report into neglect, abuse, cruelty and violence against children who were incarcerated in institutions operated by the all-powerful Catholic religious orders. The Ryan Report revealed a systemic culture of institutional secrecy behind which serious abuse and violence could fester.
The cloak of secrecy in Irish public life extends well beyond just the church-controlled institutions. The country’s civil service is routinely furtive, and this culture has dominated the health system for decades. Institutional reputation and the self-interest of powerful religious, medical and trade union groups meant that patients were far down the list of priorities for the Irish health service, much of which is still directly controlled by the Catholic Church.
One of the first serious challenges to this healthcare hegemony occurred around three years ago, with the launch in September 2006 of the website ‘Ratemyhospital.ie’. Its objective was to place the patient firmly at the centre of healthcare delivery. Its mechanism is a comprehensive 23-part online questionnaire. To date, some 16,500 fully completed forms have been submitted, covering almost 70 public and private hospitals.
Who better, after all, to say how well a hospital is performing than the people whose taxes are paying for it and who depend on its facilities? As expected, ‘Rate My Hospital’ received an icy reception from the health authorities.
The Irish Health Service Executive (HSE) put out numerous statements to the effect that ‘Rate My Hospital’ could not be trusted. Many individual hospital managers and staff reacted with indignation at the cheek of patients actually having their say.
In a system with no culture of transparency or accountability, this was to be expected. We knew however that ‘Rate
My Hospital’ was starting to make a serious difference when, in January 2007 – just four months after its launch, the HSE rushed out a facility called ‘Your service – your say’, purporting to invite the public to tell them directly about their hospital experience.
That same month, the HSE appointed a director of consumer affairs and also announced plans to train hundreds of complaints officers for individual hospitals. It is almost beggars belief that this hadn’t been done prior to this.
Not all reaction was negative. The manager of Wexford General Hospital, Theresa Hanrahan said: “Sometimes people feel more comfortable making a complaint on an impersonal level than bringing it to us face-to-face, but that doesn’t make it any less valid”. The web-based service, she added, “could be of great use to us as a tool in spotting weaknesses in the running of the hospital”.
That observation was not untypical. We were approached confidentially by a number of hospital managers, and co-operated with them in providing additional data beyond that published on the website, which they wished to use as part of their internal QA process. One manager described the feedback on the site as “gold dust” as they knew it was more objective and honest than their own patient ‘exit questionnaires’.
National media reaction was extremely positive. In one article headlined: ‘The website that forced the HSE to listen’, the author commented: “It might not suit hospitals or the HSE, but the RateMyHospital website is the injection of transparency the health service badly needed…the unbiased online rating site has kick-started a new chapter in Irish healthcare. If it wasn’t patient- centred before, it is now”.
So what has ‘Rate My Hospital’ actually found? As expected, results have been mixed, but overall, there are relatively high levels of satisfaction with the care being provided within the system. Many complaints relate to issues such as privacy, hygiene and staff courtesy – these may seem relatively minor to hospital administrators, but they have an enormous bearing on patients’ overall experience and strongly colour their attitude to a given institution.
Again, while much focus within hospitals is on doctors and nurses, patients’ perceptions are informed by all staff they come into contact with, including porters, caterers andcleaners. Hospitals that neglect this fact may be shocked to find that their best efforts go unappreciated, because some ‘non-frontline’ staff have not been adequately trained. Also, small kindnesses go a long, long way. Many patients and their relatives speak of a smile or a cup of tea at a difficult moment as making all the difference.
‘Rate My Hospital’ was never intended to be a stick with which to beat the Irish health system. All comments are manually screened to block unfair or slanderous statements. Individuals are entitled to their good name. We also have a separate channel with nearly 5,000 postings that allows people to single out staff for praise.
For many, especially the very young, attending hospital is a stressful, even frightening experience, yet for staff, it is their workplace. Better awareness on both sides leads to mutual understanding and an overall more positive experience. ‘Rate My Hospital’ has, we believe, helped build that bridge.
The project received international recognition in 2007, in the UN-sponsored World Summit Awards in Venice – the only Irish healthcare project ever to receive such an accolade. ‘Rate My Hospital’ was one of 40 winners globally, selected from some 24,000 projects the judging panel reviewed.
‘Rate My Hospital’ is operated by MedMedia Group, a wholly-owned Irish healthcare publishing organisation which also runs the successful website, Irishhealth. com, which today has around 135,000 registered members.
Publisher ‘Rate My Hospital’,
founding director of MedMedia Group