• accreditation
• anaesthesia
• attitudes

Patients and family members are the closest observers of care, with their focus on one patient in one hospital bed or clinic room. While patient-centred care is a well-accepted domain of quality, our ability to gather and use the patient and family member perspective to improve care is still relatively limited.

One potential source of data for this perspective is online reviews of care from social media sources such as Yelp, the online review site, and Facebook, the popular social networking site. These online sources of consumer-generated content likely exert greater influence than the scientifically validated measures of quality published on government-sponsored public reporting websites, such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures. The influence of online sources of patient-generated assessments of care likely reflects a number of factors: Yelp and Facebook receive far greater traffic1 than public reporting websites2; people frequently use social media for healthcare information3 4; the number of online reviews for healthcare providers has increased substantially over time5 6; and because the data are more engaging—Yelp and Facebook reviewers write narrative stories, which consumers find more compelling than aggregated quantitative experience scores.7 8

Given the increasing presence of online consumer-generated content, multiple studies over the past decade have examined whether the consumer-generated data are meaningful and whether they contribute to better informed consumers. Do they steer people to high-performing providers, thereby improving the quality of care for consumers, or to low-quality choices, leading to poor care and potentially worse outcomes?

The paper by Gaudet Hefele et al 9 in this issue of BMJ Quality & Safety adds to this literature by looking at nursing homes, a care setting not previously examined and for which …