England's Experience incorporating "anecdotal" reports from consumers into their national reporting system: lessons for the United States of what to do or not to do?

The English National Health Service's public reporting website--known as NHS Choices--has been incorporating anecdotal comments from patients about primary and hospital care since 2007. Publicly reporting patients' narrative comments along with numerical ratings of their experience and clinical quality metrics presents opportunities as well as challenges for reporting systems. This article reviews the lessons learned in England that could be useful to other health systems that are considering a similar approach. We explore five key design considerations for publicly reporting anecdotal comments--including how to collect, moderate, and display comments and how to encourage the public and the health care providers use them. While anecdotal comments might represent an untapped seam of valuable information about service quality and a potential hook for engaging patients to use comparative performance data, the jury is still out on where narrative comments fit in the complex landscape of quality measurement and reporting.