My opinion
 

By Dr. Deepak Gupta
Corresponding Author Dr. Deepak Gupta
Wayne State University, - United States of America 48201
Submitting Author Dr. Deepak Gupta
QUALITY AND PATIENT SAFETY

Online Reviews, Online Ratings, Rating Scales, Rating Apps

Gupta D. NSND (Not Sure-Never-Definitely) {YNDK (Yes-No-Don't Know)} APP: "Rate Thyself". WebmedCentral QUALITY AND PATIENT SAFETY 2019;10(7):WMC005589

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
No
Submitted on: 16 Jul 2019 01:15:43 AM GMT
Published on: 24 Jul 2019 05:47:30 AM GMT

Introduction


In the modern digital world of online ratings-and-reviews, it is important to “Know Thyself” [1-4]. Therefore, instead of being rated-and-reviewed only by strongly motivated consumers who are documenting their strongly perceived positive-or-negative interactions-and-experiences, facilities-and-providers should themselves embrace the philosophy to “Rate Thyself” wherein, through some standardized channel, the facility-and-provider should ask each-and-every consumer to rate the service received. As inspired from past thought processes [5-7], envisaged NSND (YNDK) APP can be one such proposed channel that futuristically awaits its standardization and validation by the accepting facilities/providers.

NSND (Not Sure-Never-Definitely) {YNDK (Yes-No-Don't Know)} APP


“Dear {consumer full name}, {facility/provider full name} sincerely appreciates you giving us the opportunity to provide {service full name} to you on {date of service}. For continuous quality improvement, it is highly recommended for {facility/provider full name} to get their services rated by all their consumers. However, it is a completely voluntary activity on your part as a consumer.”

 

“Before you rate {facility/provider full name} for {service full name}, do you feel coerced in any way while submitting your rating?”

 

“IF YES”

 

“Please accept our sincere apology for contacting you to submit your rating. Once again, {facility/provider full name} appreciates you giving us the opportunity to provide {service full name} to you.” THEREAFTER, END THE RATING QUEST.

 

“IF NO”

 

EITHER

 

“Last time, you had rated {facility/provider full name} for {service full name} as following:

 

“Based on your overall experience, you will DEFINITELY recommend {facility/provider full name} for {service full name} to your family and friends whenever they need {service full name}”.

OR

“Based on your overall experience, you will NEVER recommend {facility/provider full name} for {service full name} to your family and friends even if they need {service full name}”.

OR

“Based on your overall experience, you are NOT SURE regarding recommending {facility/provider full name} for {service full name} to your family and friends if they need {service full name}”.

 

Do you want to change your rating?”

 

“IF NO”

 

“Once again, {facility/provider full name} appreciates you giving us the opportunity to provide {service full name} to you.

 

If you want to write some comments, you can write them here

{FREE TEXT BOX}

 

These comments will be anonymously and confidentially provided to {facility/provider full name} as a feedback regarding {service full name}.” THEREAFTER, END THE RATING QUEST.

 

“IF YES”

 

“Please choose your rating of {facility/provider full name} regarding {service full name}.

 

“Based on your overall experience, you will DEFINITELY recommend {facility/provider full name} for {service full name} to your family and friends whenever they need {service full name}”.

OR

“Based on your overall experience, you will NEVER recommend {facility/provider full name} for {service full name} to your family and friends even if they need {service full name}”.

OR

“Based on your overall experience, you are NOT SURE regarding recommending {facility/provider full name} for {service full name} to your family and friends if they need {service full name}”.

 

Once again, {facility/provider full name} appreciates you giving us the opportunity to provide {service full name} to you.

 

If you want to write some comments, you can write them here

{FREE TEXT BOX}

 

These comments will be anonymously and confidentially provided to {facility/provider full name} as a feedback regarding {service full name}.” THEREAFTER, END THE RATING QUEST.

 

OR

 

“You have never rated {facility/provider full name} for {service full name}. Please choose your rating of {facility/provider full name} regarding {service full name}.

 

“Based on your overall experience, you will DEFINITELY recommend {facility/provider full name} for {service full name} to your family and friends whenever they need {service full name}”.

OR

“Based on your overall experience, you will NEVER recommend {facility/provider full name} for {service full name} to your family and friends even if they need {service full name}”.

OR

“Based on your overall experience, you are NOT SURE regarding recommending {facility/provider full name} for {service full name} to your family and friends if they need {service full name}”.

 

Once again, {facility/provider full name} appreciates you giving us the opportunity to provide {service full name} to you.

 

If you want to write some comments, you can write them here

{FREE TEXT BOX}

 

These comments will be anonymously and confidentially provided to {facility/provider full name} as a feedback regarding {service full name}.” THEREAFTER, END THE RATING QUEST.

Discussion


In NSND (Not Sure-Never-Definitely) {YNDK (Yes-No-Don’t Know)} APP, the auto-populating fields can be: {consumer full name}, {facility/provider full name}, {service full name}, and {date of service}. Facilities can choose and decide if they want themselves to be rated and/or their specific providers to be rated for the specific services being rated as an overall experience. Facilities can choose and decide if they want to get their general service categories rated as compared to getting their specific services rated. For example, facilities may choose to get their pain interventions rated instead of getting their epidural steroid injections rated. Moreover, consumers’ privacy violations can be contained even if consumers forget to exclude identifiable details in their free-text box comments because these securely stored encrypted comments would have to be de-identified and then confidentially shared with the facilities/providers being rated. Moreover, the identifiable connections between the comments and the consumers should be retrievable only as potential evidence when ordered by court of law during litigation among any or all the parties involved: consumers who are rating, facilities and/or providers who are being rated and rating portals who are securely storing encrypted comments connecting raters to rated. Information about NSND APP can be displayed as posters or distributed as pamphlets at front service desks of the facilities. Thereafter, to download NSND APP, the phone-text-requests can be sent to all those consumers who visit the to-be-rated facilities but have yet not downloaded NSND APP. Although email-requests to rate the facilities/providers can also be sent to the consumers, the phone-text-requests may be better because futuristically NSND APP may evolve to be used by all facilities embracing the philosophy to “Rate Thyself” through NSND APP. 

 

Essentially, while facilities/providers will have confidential access to their de-identified consumers’ free-text comments so as to shape their quality improvement responses, the only publically accessible ratings of facilities/providers will be in terms of NS%, N% and D% for each of their rated services along with the response rate (R%) of consumers wherein, for each rated service with 100% response rate being the goal, 50%-75% response rate will be tolerable but < 50% response rate may make NSND ratings worthless. Subsequently, an optimistic view of the ratings will be that R%*D% consumers definitely recommend the rated facility for the rated service to their family and friends. Alternatively, a pessimistic view of the ratings will be that R%*N% consumers never recommend the rated facility for the rated service to their family and friends. However, a realistic point of view from rated facilities’ standpoint will be that assuming all non-responders (100-R)% are also not sure just like NS% responders about recommending the rated facility for the rated service to their family and friends, the facilities can safely assume that cumulatively {(100-R)%+R%*NS%+R%*D%} may recommend the rated facility for the rated service to their family and friends. Similarly, a realistic point of view from current and future consumers’ standpoint will be that assuming all non-responders (100-R)% are also not sure just like NS% responders about recommending the rated facility for the rated service to their family and friends, the consumers may safely assume that cumulatively {(100-R)%+R%*NS%+R%*N%} may NOT recommend the rated facility for the rated service to their family and friends.

 

Essentially, this facilities/providers-endorsed initiative may allow them to have fair shot in the digital world ruled by views and reviews which can often make survival of facilities/providers an ordeal of losing battle. Even though Pete Blackshaw’s quoted “three-vs.-three-thousand” analogy may seem overstated and over-exaggerated even in consumer generated media (CGM) world [8], the human minds are preferentially attuned to listening, reading and reflecting fellow human beings’ dissatisfactions by presuming them as warnings of dangers which can limit their own survivals. Evolutionarily, ignoring the dangerous contexts and overlooking the gossiped contents may essentially have been matters of life and death for individuals or even their consortiums, groups, communities and societies. 

 

The need of the hour is standardized channels for rating facilities/providers because (a) facilities/providers’ online responses to online reviews posted by patients (consumers) can often amount to Health Insurance Portability and Accountability Act of 1996 (HIPAA) violations when practicing healthcare in the United States [9-10]; (b) deletion of abusive reviews along with blockade/deletion of abusive reviewers’ accounts may not be successful; (c) litigating the consumers or reviewers or websites for defamation may make the ordeal more arduous [11]; (d) online reviewing and commenting about facilities/providers may be just a call for help by consumers (patients) who are feeling helpless and powerless despite the multitude of opportunities of grievance (complaint) redressal through formalized reporting processes like to the licensing boards, accreditation authorities, third party payers like insurance companies and personal injury litigators; and (e) decoding and understanding the online reviews’ text cannot be amateurish thereby warranting the need of professional companies to be hired specifically to manage the feedback-related-changes in the quality of service provided by the facilities/providers while keeping facilities’/providers’ business as well as their reputation intact. The only disadvantage of using NSND APP will be that the consumers/facilities/providers will not only not see bad/defamatory free-text comments/reviews in the public domain maintained through NSND APP but they will also not see good/promotional free-text comments/reviews in the public domain maintained through NSND APP. The absence of free-text comments/reviews from public domain and replacing with them with simple NSND percentages is to ensure that one consumer whether satisfied or dissatisfied is counted as one and thus able to tell only one-potential consumer reading only the NSND APP percentages instead of free-text comments.

Conclusion


Summarily, to overcome the presumed preponderance of berating and scathing reviews, the facilities/providers must begin rating themselves through standardized channels so that neither the quality of service nor the quantity of business is harmed in the due course because timely feedback is received and appropriate action is taken to sustain the balance between quality of service and quantity of business.

References


  1. Sabin JE. Physician-rating websites. Virtual Mentor. 2013 Nov 1;15(11):932-6.
  2. Emmert M, Sander U, Pisch F. Eight questions about physician-rating websites: a systematic review. J Med Internet Res. 2013 Feb 1;15(2):e24.
  3. Jha AK. Health care providers should publish physicians’ ratings. https://cat alyst.nejm.org/health-care-providers-should-publish-physician-ratings/
  4. Drucker P. Know Thyself Helps You Manage Yourself by Peter Drucker. http://masonmyers.com/pete r-drucker-managing-oneself-know-thyself/ Last accessed July 12, 2019.
  5. Gupta D. Anesthesia care providers' based interdisciplinary peri-operative cross-over post-market--safety-surveillance: is it futuristic patient safety idea? Running title: post-hire PMSS for interventionists. Middle East J Anesthesiol. 2014 Jun;22(5):527-30.
  6. Gupta D, Drabik A, Chakrabortty S. A New Nominal Scale (Yes-No-Don't Know-YNDK Scale) and Its Correlation with Standard Ordinal Scale (Numerical Rating Scale-NRS): Our Experience Among University Based Pain Clinic Patients. WebmedCentral PAIN 2016;7(11):WMC005226.
  7. Gupta D, Alshaeri T, Patel P. Is It Time to Review The RUSH For Start Times in Operating Rooms from Patients' Perspectives? Our Limited Data Results Over One Month Period Based On Yes-No-Don't Know (YNDK) Scale. WebmedCentral ANAESTHESIA 2017;8(4):WMC005267.
  8. Blackshaw P. Satisfied Customers Tell Three Friends, Angry Customers Tell 3,000: Running a Business in Today's Consumer-Driven World. https://www.amaz on.com/Satisfied-Customers-Three-Friends-Angry/dp/1400157315 Last accessed July 12, 2019.
  9. Ornstein C. Small-Scale Violations of Medical Privacy Often Cause the Most Harm. https://www.propublica.org/article/small-scale-violations-of-medical-privacy-often-cause-t he-most-harm Last accessed July 12, 2019.
  10. Johnson D. Respond to health care reviews online without violating HIPAA. https://www.healthcarecommunication.com/respond-to-health-care-reviews-online-without-viol ating-hipaa/ Last accessed July 12, 2019.
  11. O'Donnell J, Alltucker K. Doctors, hospitals sue patients who post negative comments, reviews on social media. https://www.usatoday.com/story/news/politics/2018/07/18/doctor s-hospitals-sue-patients-posting-negative-online-comments/763981002/ Last accessed July 12, 2019.

Source(s) of Funding


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Competing Interests


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