Changing Technologies of Feedback and Complaint in the Scottish NHS

The proposed PhD will conduct the first examination of the relationship between formal complaint systems and online feedback platforms in the UK, focusing on Scotland. We will work closely with our partner organisation Care Opinion (CO) (careopinion.org.uk) - a non-profit platform where people share experiences of health and social care online, to address the following questions:

- How and why do people turn to online feedback platforms to raise concerns about the healthcare they or their family members have received? And how do their online feedback practices relate to and intersect with the pursuit of a formal complaint?

- How are online feedback platforms interacting with and potentially changing formal complaint procedures? What implications does the emergence of platforms that enable the public and anonymous sharing of critical comments have for people's relationships with healthcare services and practitioners in the UK?

- What are the consequences (for patients, staff and services) of a concern being reported on a public feedback platform, instead of, before, after, or overlapping with a formal complaint?

- How do online feedback platforms and complaints procedures differ in the extent to which they enable marginalised groups to voice dissatisfaction with healthcare? What is the nature of these different forms of voicing and how are complaints heard differently across different technologies?

- How do healthcare practitioners and those working with complaints deal, both practically and emotionally, with publicly available critical comments?

Technologies of complaint and feedback will be conceptualised within the 'affective atmospheres' of the NHS (Anderson, 2009), a politicised and much-loved national healthcare system. Using ideas and concepts from Science and Technology Studies (STS), careful attention will be paid to how concerns and complaints about healthcare, and healthcare staff and organisational responses, are shaped by the technologies through which they are expressed as well as the wider materialities of institutional culture, procedures and processes.

The project will contribute to ongoing debates on changing technologies for the management and governance of public services, and patient and public involvement (PPI) in healthcare. Methodology

Study 1 will map the history of 'technologies of complaint' in healthcare, focusing on the NHS, but comparing and contrasting this to other national healthcare contexts where relevant. Using critical discourse analysis (Wodak and Meyer, 2009) and interpretative policy analysis (Yanow, 2010), it will unpack how healthcare complaints have been articulated, understood and enacted over time, in relation to different technologies, practices and policies.

Study 2 will be a qualitative secondary analysis of the CO archive of online feedback and responses (Heaton, 2019), including posts and responses where people: i) share experiences of complaint procedures and; ii) reference complaints in relation to online feedback. CO meta-data will be used to contextualise posts (e.g. in relation to time, user demographics, and healthcare service).

CO will provide practical support on design and implementation, ensuring research questions can be answered given available data, searching and sorting mechanisms.

Study 3 will be qualitative interviews with people who have posted feedback online, those who work with it, frontline staff responding to it, and those integrating it into health improvement initiatives, relevant healthcare policy-makers and healthcare professionals. The aim is to generate in-depth insights into overlaps, conflicts and synergies between online feedback and formal complaints.

Themes identified in Studies 1 and 2 will inform interview protocols and questions. CO will input into sampling and recruitment, advertising the study to platform users and across their network, identifying and introducing the student to potential interviewees.