West Australians can cause real change in hospitals through a social media site that aims to transform provider-patient relationships through storytelling.
Patient Opinion Australia allows anyone with a story about a hospital or GP visit, good or bad, to tell it anonymously online and have it immediately emailed to all staff concerned.
Staff and managers can, in turn, respond through the website and have responses anonymously published alongside a record of any changes made. Storytellers are notified of receipts, readings and responses.
A similar system has operated for about a decade in the United Kingdom, and since its Australian counterpart opened in 2012, about 50 east coast providers have taken up the service. 
WA is now testing the waters, with WA Country Health Service hospitals and clinics responding to stories, led by Kimberley regional clinical services director David Gaskell, who championed the WA pilot after his UK experiences.
'It's a goer' in the Kimberley
Dr Gaskell said Patient Opinion was a "tremendous innovation", allowing hospital staff to turn tales already being told online, in pubs and on street corners, into "timely and constructive" exchanges.   
Stories told on the website show the numbers of both members of the public and staff who have read the story - in this case, 20 staff members read the feedback.
He said all healthcare users had stories to tell, often difficult ones about pain, embarrassment or rudeness, but they usually just told people they knew.
Health staff would hear stories through formal complaints or social media, but usually long after the issue was over and they could not safely engage on Facebook.
He encountered wariness about Patient Opinion from staff at first, who felt they might be exposed and criticised, but the reality had been different.
"People share as many good experiences as bad," he said.
"When they don't, we are able to tackle it right now.
"We need not fear the consumer ... we are all consumers of healthcare."
One woman told Broome Health Campus her daughter received good care but was stressed by sharing a small ward with very sick patients and only told at the point of discharge that her private health insurance would have got her a private room.
This story led to a change.
As a result, hospital management reminded all clerical staff responsible for booking patients to go through that information for patients, and also featured that information more prominently on its web page.
The story 'A Bit of a Heart Scare' appeared online and was responded to within a day, with feedback and appreciation shared immediately with staff, Dr Gaskell said.
"This story has already been read by 50 public users and 17 staff members in less than 24 hours," he said.
"This is nothing but a good development for WA health. We have the collective experience of 10 years' use in the UK where it has just been an outstanding success.
"It's a goer, it's effective, it's smart, it's cost-efficient."
Anatomy of a 'social movement'
Chief executive Michael Greco said Patient Opinion was not just a website but a social movement.
He said normal feedback systems, such as surveys, official complaints letters and suggestion boxes, were useful... but:
Patient Opinion Australia chief executive Michael Greco says the not-for-profit represents a social movement in health care. Photo: Supplied
      They were about data collection, and individual stories got swallowed up;   They were not transparent or independent;   They asked questions they wanted answers to, rather than letting patients share freely;   People avoided making official complaints for fear of repercussions;   People avoided giving feedback because they felt it was pointless;    In-house systems prevented organisations learning from each other.    
By contrast, Patient Opinion was public, independent, moderated, protected staff and patients, prompted action and allowed sharing of learning.   
"What happens in WA can benefit Queensland. Everyone can see how services are responding and doing differently - many organisations say they have got ideas," he said.
Another was the ease of sharing positive stories - which made up half the feedback - with both staff and management.
One WA consumer whose premature baby was delivered safely wrote a story entitled "Our Premature Princess."
"This was the most terrifying moment in both our lives. We owe so much to the staff that attended to us here with their quick actions and absolute professionalism, from the midwifes to the doctors, paediatric nurses, paediatricians and everyone else involved," they wrote. 
Professor Greco said consumer knowledge and experience was the health system's most underused resource and the only way forward amid tight fiscal resources and rising complaints.
Health workers can also take part safely, and make up 2 per cent of stories shared.
The site tries to pass stories on to hospitals mentioned regardless of subscription - which is why Fiona Stanley Hospital, for example, though not a subscriber, is mentioned in stories and marked as having read them.
The searchable website shows which stories have been responded to and which have sparked change.
But subscribers get the full package, which includes promotion materials, reports and analyses of story numbers, viewings and general tone.
The service is free to the public.
Professor Greco said there was "huge fear" in organisations about exposure, despite the high numbers of positive stories, but loved it once they engaged with it.
The chief executive of a major Victorian health district had told him complaints had reduced by more than half over the past eight months as a direct result of engagement.
The 150 stories told in that time received more than 50,000 views.  
Professor Greco said on average, every story on the Australian site was read 300 times. In the UK, after a decade, it was 3000 times.
Removing barriers 
Health Consumers' Council of WA executive director Pip Brennan said Patient Opinion's immediacy, transparency and focus on the "whole cycle" supported "vital re-orientation" to place consumers at the centre of health debates.
Health debates need to be centred around the consumer, Health Consumers Council of WA executive director Pip Brennan says.  Photo: Supplied
"Real wins in terms of better services, and less waste, can be achieved through the inclusion of the consumer voice," she said.
She said the single entry point removed the barriers people often faced in complex official feedback systems, which were often managed only from the perspective of providers and administrators.
The inclusion of positive stories was also valuable.
"Consumers are very grateful for the care they receive in their hour of need. Even stories which appear as negative feedback often have a mixture of positive and negative comments when looked at more closely," she said.
She called for the expansion of the pilot across the state.
The WA Clinical Senate, a forum allowing clinicians to form advice for politicians, discussed the website at its most recent debate, is also finalising a recommendation to the WA Health Department to expand the pilot across the state.
The WA Country Health Service trial will soon expand to the Mid West and Gascoyne.
WA Primary Health Alliance, which funds the state's three primary health networks, is considering subscribing.
So far in Australia the 50-odd organisations taking part are mostly hospitals, government departments and primary health providers in Queensland, New South Wales and Victoria.  
The system is operating in Ireland and will soon be operating in the Middle East, Canada, United States and New Zealand.
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