Shortly after giving birth to a baby boy, one of the new mums seemed flustered when the attending midwife reached over and embraced her with a kiss on the cheek, telling her that she was proud of her. It was intimate, warm and loving and not something I've seen happen during any other labour featured on the show. It’s certainly not something you'd expect from other health care professionals, a kiss and a cuddle from the surgeon who'd just removed your kidney stones would be fairly unusual.

This may not fit with everyone's definition of love, but in my interpretation it is without doubt a loving and affectionate gesture and behaviour that falls outside of the standard role of the midwife. I’m sure it’s more a reflection of the midwives personality than the circumstances, but it got me thinking about the part that love has to play in health care.

People often talk about their professional personas and how much they differ from the personalities they express outside of work. Acting 'professionally' has connotations of suppressing the softer side of your character and portraying a more corporate, task focussed demeanour. But in a world where teachers are warned that hugging a crying child who has fallen in the play ground is acting outside of 'professional boundaries', are we forgetting how important it is to be human at work?

In the report we released this time last year, it couldn't have been more conclusive that the attitudes of staff and a lack of care and compassion were the most frequent causes for complaint or concern for patients of our health service. The same is true for compliments; what people are most thankful for when receiving health care is feeling like the staff cared about them.

So people certainly notice and appreciate kindness, affection and loving behaviour but is there any evidence to suggest that this has any impact on health outcomes?

The King's Fund Point of Care programme(2009) noted that:

'Research evidence suggests that compassion affects the effectiveness of treatment. For example, patients who are treated by a compassionate caregiver tend to share more information about their symptoms and concerns, which in turn yields more accurate understanding and diagnoses (Epstein et al, 2005).

'In addition, since anxiety and fear delay healing (Cole-King and Harding, 2001), and compassionate behaviour reduces patient anxiety (Gilbert and Procter, 2006), it seems likely that compassionate care can have positive effects on patients' rate of recovery and ability to heal.'

It's clear that experiencing compassionate care, and in this context love, from health care staff matters enormously to patients, both in shaping their impression of health services and in their recovery.

For staff, showing compassion to people at their most unwell or vulnerable is often at the heart of their motivation for joining the NHS. It's my impression from reading the stories we receive that the majority of staff are striving to show patients the affection and kindness that makes all the difference, but that staffing issues sometimes get in the way. So how can we help to ensure staff always feel comfortable and capable of delivering this level of care?

The King's fund paper goes on to suggest that:

'In the practical circumstances in which staff caring for patients feel under pressure, and experience themselves as having very little time, it is often difficult to do just that one thing for the patient that makes her or him feel cared for. Enabling staff to feel and be compassionate towards patients in their care, at all times, requires action on multiple levels.

One of the most powerful resources that healthcare professionals consistently cite is patients' stories.

Every day here at Patient Opinion we continue to make available stories from patients that detail how it feels when compassion is lacking and what truly compassionate care looks like. I'm reminded of a beautiful quote from a story we received some time ago which recorded a moment between a member of care staff and the author's nan:

'One day I heard one of the staff, Tracy, talking to my nan as they were bathing her. Tracy was lovely with her and so caring and sensitive - I can't imagine it's easy to bathe a grown person. Tears came to my eyes, I was touched by the care and respect demonstrated. No one knew I was close to the bathroom door and could overhear what was being said, this wasn't a demonstration put on for my benefit.'

Thinking back to the midwife on One Born Every Minute, her attitude, warmth and willingness to give a little bit of herself makes me hopeful. The interaction between her and the new mum on the bed depicted everything that I know to be the right way to treat a person and I'm reassured to see that either in line with or in spite of policy, treating a patient with love prevails.

If you havn't yet seen it, our director James Munro wrote a great peice for The Guardian this morning. It's a gentle but optimistic warning about the problems the Government might encounter as they bring in a ratings system for care homes. Worth a read, even if we do say so ourselves.

James' peice for The Guardian - "Beware of the pitfalls of rating care homes" (15/12/2011)

Patient Opinion has now reached 31,000 published stories.

In my last post, I rashly challenged someone to show me online comments about care homes. I called and the internet answered, in the form the lovely Best Care Home,who show the best of care homes, by encouraging positive reviews about CQC 3star rated care homes. As Debbie says“it is about time we heard some positive news about [care homes]”.

This got me thinking… What is the advantageof having critical feedback about care homes? Or, rather, what is feedback for?At Patient Opinion we feel that our aim in healthcare is to facilitate changethrough getting just the right patient story to just the right person in theNHS. This change would not be possible if it wasn’t for the stories having acritical element. Increasingly, this is how public services are changing,through service users donating their experience, to make a difference foreveryone else. The patient is a becoming a co-creator of the service.

So, is there a difference for privatesector organisations like care homes? Both care homes and NHS hospitals areoften demonised by the media, both are plagued by funding issues, and choice isan issue for both. So… the difference? The care home sector is in constantbalance between care and money. The majority of care homes are privatecompanies, with reputations to manage. An understandable fear is that criticalpublic feedback will impact on negatively on their reputation, and then impacton the number of future residents. Maybe the difference isn’t so great then –as hospitals have a reputation to manage, and wish to attract patients.

Which leaves me wondering, what are theoptions for care homes, when faced with online feedback? The options are: sue anyonewho allows people to write critical comments, or choose to engage with theseconcerns online. It’s not an easy path to follow, but embracing thetransformative power of the web might allow care homes to discover a new placein the 21^st Century.

How far can you push the Patient Opinion model? We've been thinking about this a lot as we get ready for our MyPublicServices Conference that we are putting on in November. We know that its surprisingly easy to extend it to other countries (providing you have great local people to work with!) and our Catalan, Spanish and Italian versions should go live soon. But what about extending sideways to other sectors within the UK? What about Social Work Opinion? Or Education Opinion? Well, quite a few people are trying to do this and we wish them well as we have no ambition to extend beyond health and social care. But we do have some thoughts about this extension?

First off does it make any sense to have a single system of feedback? Apart from convenience of accessing and promoting a single site (which can be handled in much better ways than creating a single portal) does the citizen gain anything else? Well, yes, if it means they can tell complex stories involving multiple providers, issues and places in a way that makes sense to them. But to do this well the system needs be able to handle each bit of the journey in an appropriate way. Commenting about your social worker for example probably raises issues particular to this field that need to be handled sensitively.

Which begs the question what is the nature of ‘appropriate’? Is there anything we learnt from Patient Opinion about what ‘appropriate’ means for web-based platforms?

Roughly speaking public services can be divided into those that are transactional and those that are based on some kind of personal relationship. The touchstone here is whether you, as a user, have a relationship with at least one or two of the key people providing the service. FixMyStreet and its generic descendents FixMyRailways, FixMyRoadworks and FixMyFlyTipper are all clearly transactional. Social Work Opinion, Pupil Opinion and Probation Opinion would, like Patient Opinion, be at the relational end. Our guess is that it’s much easier to build a generic service for transactional services than for those based on relationships.

This is only in part because the ethical, legal and business knowledge needed to generate income from relational feedback is highly specialized. It’s because users want a relationship. They want to feel heard by their doctor, they want a response from their teacher, their probation officer. They want to touch, feel, affect the relationship they already have. That’s why they are posting their story in the first place.  Just providing a place that does to the professionals they have been dealing with my cathartic to the angry and the frustrated. But it does a violence to the majority of people who come on sites like Patient Opinion and I Want Great Care.

Complicating all this further is the rhetoric of the web. Built around consumer sites both the rhetoric and the formal research about web users tends to concentrate on desire driven events. Health care, social work and the criminal justice tend to be fear and anxiety driven. Just think about the difference between sharing the story of your wedding on FaceBook or the story of your haemarhoidectomy on Patient Opinion. Get the picture? So the standard script about web sites – that use matters, that hits and clicks are the only currency – just doesn’t work on for many public services. Not only does this mean that the standard advertising driven models don’t hold up (what services would you advertise on Social Work Opinion?). It also means learning what drives users to use the site has to be discovered. It doesn’t just fall fully formed off FaceBook or out of the Twitter tree.

So where the beef here? Maybe that a generic model is practical for transactional services but that for relational services it’s better to build a flotilla of sister organisations who each specialize in a sector, manage it’s particularly risks, and who know and love it enough to generate income. With the whole lot held together by a loosely evolving software systems that have enough inter-operability to provide seamless storytelling to users. Which is more or less the direction we’re interested in taking Patient Opinion. So if there are any budding fellow travelers out there who want to colonise a new sector, come and talk to us!