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Dr James Munro Interview

By Dr Fergus Fairmichael.


Dr James Munro is chief executive and chief technology officer of Patient Opinion. He has a background in clinical medicine, public health and health services research.

Patient Opinion was founded in 2005 and is now the UK’s leading independent non-profit feedback platform for health services.  Patient Opinion is about “honest and meaningful conversations between patients and health services with the belief that patient stories can help make health services better.”

Interview Synopsis

There is a large overlap between Patient Opinion and the concept of the Learning Healthcare System.

Patient Opinion sets out to provide a real time platform for feedback from patients and carers. It aims to bring about learning and change from people’s experience of care. It creates a rapid, online, public, local feedback loop that demonstrates to people that their issues are listened to and acted upon.  This can allow a wider culture of change – often policy, regulation and academic research overlook patient input.  Patient Opinion creates clear incentives for feedback to be used.

Patient opinion has grown successfully since its beginnings in 2005 and is now working effectively across the country. 90% of trusts in England use Patient Opinion and the model has begun to take off in other countries such as Australia and Ireland.

The Patient Opinion method of delivering feedback and change is highly scalable at low cost and other healthcare bodies such as regulators and commissioners now use Patient Opinion feedback to help guide their work.

Bringing about change

Using data, analytics and publishing papers does not in itself produce change. There is a recognition that there are many processes to bring about change, such as guidelines, and Patient Opinion is one method that is very effective and fits with certain values that are focussed upon creating a mutual relationship, that is not just one way, for the benefit of the system. The first priority is to respond to the individual and show that feedback has made a difference. Patient Opinion is very much focused on this relationship.


The model of Patient Opinion is that the patient puts their information in the public domain with the understanding that it can promote change based on their feedback. In other systems, the type of consent required should depend on the source of the information, how it is collected and the purposes for which it is used.

Change in opinion

Patient Opinion has grown steadily since 2005, in line with a steady increase in public expectations that there should be online feedback and that action should be taken as a result. During this time there has been a dramatic change:
• There is now an expectation for the health service to communicate online
• There has been a change in public opinion regarding sharing of opinions

  • • This has become more acceptable to both patients and staff, people increasingly share intimate details on social media
  • • Initially people did not understand the reasons for Patient Opinion and did not see the value in hearing patient experiences but this has become recognised as a driver for change

Types of feedback mechanisms

Feedback should be both actively sought and optional, this should not be an either/or question. An example of sought feedback is the Friends and Family Test.  This asks if patients would recommend the service along with follow up questions depending on the type of service.
Patient Opinion differs in its perspective to this type of feedback and enables people to share specific opinions in public in ways that lead to widespread learning and culture change.  It is not about the collecting of data but focused on connecting people who have experiences with those who want to hear their experiences.  This approach fits with different values and different understanding of how to go about change than other feedback mechanisms.

Change in the Doctor/Patient relationship

There are several different organisational approaches to dealing with the feedback gained:
• Some organisations use the Patient Advice and Liaison Services (PALS) to process feedback
Other organisations ensure that clinicians themselves become involved with the feedback received, and are receiving feedback in real time and responding. These organisations have enjoyed the greatest improvements.
• This greater improvement may be because the feedback provides healthcare professionals with a fresh perspective on how care fits into the patient’s life and expectations.  This broadens clinical views where it is taken on board at the clinician level.


Dealing with feedback is increasingly becoming part of the basic education of all healthcare professionals with Patient Opinion now being involved in a number of university courses. Those coming through higher education courses are digital natives with online feedback being used more often and being viewed as normal. There are immediate benefits from future healthcare professionals having this starting point.