In the previous paper in this series (Ellis, 2025), we identified how learning lessons in health and social care settings can be important in helping avoid the repetition of mistakes. We also saw that ignoring feedback, including complaints, compliments, surveys and whistleblowing, can have dire consequences, not only for individual patients, but also for organisations and wider systems of care.
We saw how feedback, used in learning lessons, comes in a variety of forms such as comments, suggestions and complaints and from surveys. We also identified that it is important to collect, and consider, feedback not only from patients, but also families and other professionals to ensure a more complete view on the provision of care. We considered how such information is only one element of the information managers need to better understand in order to be able to develop their services.
In this paper, we will consider how lessons can be extracted from feedback, how the leader can, with their team, reflect on this feedback and how they then go on to share the learning within and externally to the team. We will identify that in adopting a proactive approach to working with feedback, teams become more resilient.
Extracting lessons from feedback
While much lip service is done to the development of services both locally and nationally in response to patient feedback, the reality is, as Flott et al (2017) suggest that much of what is collected in the way of feedback is left “dormant and underutilised”. As such, while the feedback is collected, nothing meaningful is done with it.
Flott et al’s (2017) observation is reflected at team, organisation and national level where vast swathes of data are collected and infrequently collated and analysed and then very little is done with any outcomes. If feedback is not collected then care providers cannot know how what they do is experienced and perceived by others. They cannot consider these experiences and cannot use them to grow and improve.
Lessons from feedback can only be meaningfully extracted if they are looked for. This means managers need to take the opportunity to uncover the real meaning behind all forms of feedback, collate this information and be prepared to reflect on and share this with the team in a meaningful way.
One way of starting to do this is to collect all feedback in one place, such as on a spreadsheet, and use this information to look for trends in issues such as:
- Feedback that identifies similar issues (remembering these can be positive as well as negative or neutral)
- Feedback which triangulates other forms of feedback. That is when different types of feedback, or feedback from different categories of people, identify the same issues
- Contradictory feedback — some people may consider something to be a negative experience when other see the same thing as positive
- Outlying feedback which may contain issues others have failed to raise but which nevertheless could be, or become, problematic
- Informed feedback — from other professionals or people with significant insight
- Feedback about individuals
- Feedback about processes, for example waiting lists or how information is shared
- Feedback about things, for example cleanliness, seating, availability of water
- Feedback about issues, or behaviours, which may be worrying and need immediate attention.
It is only by collating and reviewing feedback in this way that patterns within the feedback can be seen to emerge. For example, if a manager gathers feedback from a few surveys about an issue or an individual, as well as gathering verbal comments from patients or staff, then they can be relatively sure that the issue is genuine and needs their attention. Dealing with an issue before it becomes a complaint or before someone gets hurt, or worse, makes the gathering of feedback meaningful.
Complaints also have an important role to play in enhancing the quality of health and social care services. van Dael et al (2020) make the point in their review of the academic literature that if healthcare services were better at reporting and analysing complaints and use the data generated this would have a positive impact on care quality.
Råberus et al (2019) make a useful observation when researching patient experience of care in Sweden. They note that of the 5,689 complaints they reviewed that the complaints fall into six distinct categories but that they all identify the need to improve communication a focus on meeting patient needs and preferences at both an organisational and individual level. While this is a research study, it is a facsimile of the processes a good manager would use to better understand the deliver of care in their organisation.
Reflecting on feedback
Many managers mistakenly consider reflection to be a solitary undertaking, where they collect feedback and go away and think about it themselves. While there is a place for self-reflection, reflecting with others, including colleagues is important in the development of the workplace and in addressing workplace issues and behaviours (Bozkuş and Göker, 2017). Reflecting with others is important for a number of reasons:
- The feedback once it gets to the manager may have lost its context, this can only be retained by reflecting with others — often the people to whom the feedback first came
- Managers will, by definition, apply a management interpretation to feedback, which may mean they miss what the person giving the feedback meant
- If managers want to develop and then embed new practices, these need to be accepted and applied by staff.
Reflection with others can take many forms. This includes reflecting on feedback in supervision with individual staff. This is especially powerful when it is with an individual that the feedback is about. Asking questions such as what did you do to get this feedback? What could be done better? What could we do to ensure everyone gets this positive/negative feedback in the future? What lessons can we take from this to share with your colleagues? Can be applied to feedback which is both positive and negative and can be powerful motivators.
Group supervision and team meetings are also valuable places in which to share lessons and to learn together (Lavery et al., 2016). Again, the role of the manager might be to ask questions, even if they think they know the answers, because when the team supply the answers or unpack the feedback, the lessons learnt very much belong to them.
In their study of team learning behaviours and team culture, Pinheiro et al (2022) identified how team cultures that promote good communication and shared objectives and a willingness to search for different ways to get things done are more likely to exist in team cultures in which learning and experimenting are valued.
Making meaningful changes
While there is some cause to be sceptical about the translation of patient feedback into meaningful changes in the care setting (Wong et al, 2020), it is at least a good place to start. For most teams and organisations whose managers and leaders are seeking mechanisms by which to develop their cultures of care, as well as their patient offering, patient feedback is a crucial part of the evidence they need — but it is not all they need and so the development of structures and process to collect collate and reflect on a variety of forms of feedback is important.
As we have seen, teams which learn together, and which foster cultures of learning and openness, and honesty are more resilient. That is, they work better together and can withstand periods of uncertainty as well as responding robustly and effectively when things go wrong. Such teams are open to meaningful change because they are part of the process.
Conclusion
In their guidance to civil contingencies planning and resilience, HM Government (2025) when discussing the value of lessons management define it as: “a strategic, organised approach to, and oversight of, planned processes and procedures to achieve evidenced learning from experience in a continual, consistent, manner. The purpose of Lessons Management is to successfully close the loop between identifying lessons and achieving positive, lasting, improvements in practice.”
This captures the key messages of this paper, which has explored how to extract and collate messages from diverse places and use them to generate meaningful learning and development for teams and organisations.
This paper has also identified how reflection is a key element of the process of enabling individuals, team and organisations to consider what learning can be taken from collated feedback in order to inform meaningful change.
