Ivie Itua
Clinical Research Fellow, Imperial College London, London, UK

Learning Points

• Communication is a core clinical skill, not a soft one.
• Accessibility and interpreter provision are clinical safety imperatives, governed by the AIS.
• Empathy and professionalism are measurable determinants of satisfaction.
• Small service evaluations provide immediate educational value, linking feedback to reflection and improvement.

Abstract

Background: Patient and parent experience is central to the quality of paediatric ophthalmic care, influencing adherence, trust and importantly outcomes.
Aim: To evaluate satisfaction within a UK paediatric ophthalmology clinic, highlighting key learning points for clinicians.
Methods: An anonymous questionnaire was distributed to patients and their carers attending routine appointments through google forms.
Results: Five responses were collected. Overall satisfaction was high, with 80–100% of participants agreeing that clinicians were courteous, communicative, and thorough. However, one respondent reported that an interpreter was not provided for a deaf parent, exposing a gap in accessibility compliance.
Conclusion: This small-scale evaluation highlights the educational value of service reflection. Embedding inclusive communication, empathy, and reflective learning into daily practice strengthens both the quality and humanity of paediatric ophthalmic care.

Introduction

Patient experience is a recognised pillar of healthcare quality, alongside clinical effectiveness and safety, and strongly correlates with improved outcomes and adherence (1). In paediatric ophthalmology, communication is complex, requiring clinicians to balance diagnostic explanation, parental reassurance and child engagement. Children and their families frequently attend multiple visits for amblyopia, strabismus, or postoperative care, where clarity and empathy foster trust. Service evaluations provide a structured means of assessing how effectively teams deliver these values. This reflective evaluation sought to assess patient and parent satisfaction in a paediatric ophthalmology clinic, identify areas for improvement, and explore lessons for ophthalmology trainees on communication and accessibility, framed within the NHS Accessible Information Standard (AIS) (2).

Methods

A short, anonymous questionnaire was distributed to patients or their carers attending paediatric ophthalmology clinics at a UK Based Hospital between November 2024. The 18-item survey used 5-point Likert scales (Strongly Agree to Strongly Disagree) across domains of communication, professionalism, accessibility and overall satisfaction, with an optional free-text section for comments.

Participation was voluntary and anonymous. As a service evaluation conducted for quality improvement, formal research ethics approval was not required under the Health Research Authority framework (3). Responses were analysed descriptively. Free-text comments were reviewed to identify examples of good practice and opportunities for improvement.

Results

Five patients accompanied by their carers completed the survey (Table 1.) The median patient age was 7 years (range 5–13); 3 (60%) were male and 2 (40%) female. Sixty percent identified as White British or White Other, 20% as Black or Black British, and 20% as Other ethnic group. Three families (60%) had attended more than two appointments. The survey revealed strong satisfaction across communication, professionalism, and access. Parents highlighted positive rapport and staff kindness. However, the single report of an interpreter not being booked for a deaf parent identified a critical shortfall in communication accessibility. Names were replaced with ‘XX’ for confidentiality purposes.

Domain	Findings
Median patient age (years)	7 (range 5–13)
Gender	3 Male (60%), 2 Female (40%)
Ethnicity	3 White British/Other (60%), 1 Black (20%), 1 Other (20%)
Clinic attendance	3 repeat visits (>2), 2 new
Doctors explain reasons for tests	80% Agree/Strongly Agree
Clinic equipped for care	100% Strongly Agree
Doctors friendly and courteous	100% Strongly Agree
Doctors spend adequate time	60% Agree/Strongly Agree
Ease of getting appointments	100% Disagree with “hard to get”
Overall dissatisfaction	20% (1 respondent)
Qualitative comments	“The gentleman named XX who did the eye test was fantastic with my child.” “Not even book interpreter for mother who is deaf.”

Discussion

This small-scale evaluation illustrates the importance of communication, empathy, and accessibility in paediatric ophthalmology, offering valuable lessons for clinicians and trainees. The consistently high satisfaction with explanations and courtesy reinforces that effective communication remains the most powerful determinant of patient trust and cooperation (4). In paediatric ophthalmology, the clinician must communicate simultaneously with the parent (for understanding and reassurance) and the child (for engagement and comfort).Trainees should view every consultation as a structured educational opportunity: explaining diagnostic reasoning, using diagrams or models for visual learning, and verifying understanding through “teach-back.”(5). These techniques improve retention and reduce anxiety for both child and parent.

Tailoring communication to a child’s developmental level requires specific strategies. Simplifying terminology, maintaining eye contact, and involving the child in small decisions to reduce anxiety. The British Psychological Society’s Paediatric Communication Guidelines provide practical, evidence-based recommendations for age-appropriate dialogue and parental involvement in healthcare discussions (6). Such principles are directly applicable in paediatric ophthalmology, where successful examination often depends on maintaining a calm, trusting dynamic.

The lack of interpreter provision for a deaf parent, although isolated, is profoundly instructive. The Accessible Information Standard (AIS; DCB1605/DAPB1605) mandates that NHS organisations identify, record, flag, share and meet communication support needs, including interpreters, accessible documents, or visual aids (2,7).Failure to comply undermines equity, safety and trust. In paediatric ophthalmology, where parents facilitate treatment adherence (e.g., patching, medication, follow-up), miscommunication can directly affect outcomes. For trainees, understanding the AIS is essential. Accessibility is not an administrative responsibility but a clinical duty, foundational to ethical, patient-centred practice.

The mention of a named staff member who “made my child happy to be there” highlights the transformative effect of empathy and warmth. Emotional intelligence, the ability to perceive and respond to emotions constructively, has been linked to higher patient satisfaction and team cohesion (8). For paediatric clinicians, empathy is both therapeutic and diagnostic: a child who feels safe cooperates better, yielding more accurate assessments.

Although limited in sample size, small reflective audits allow ophthalmology trainees to understand patient feedback at a granular level. Reflection on even five responses can uncover operational insights, such as communication gaps or waiting-time frustrations.
Service evaluations like this teach the principles of continuous quality improvement (CQI) and align with the Royal College of Ophthalmologists’ Quality Improvement Framework (3). Embedding short feedback cycles into clinic governance meetings can transform individual experiences into collective learning. Over time, such iterative reflection contributes to a learning health system, where data from daily practice continuously informs better care (9).

Conclusion

This reflective evaluation demonstrates that even small datasets can yield significant insight. Families described their experiences positively, praising communication and kindness, while a single comment highlighted a systemic gap in accessibility. For ophthalmology trainees, the key lesson is clear: excellence in paediatric ophthalmology extends beyond technical skill; It resides equally in communication, inclusion and reflection. Embedding these principles within everyday clinical encounters ensures care that is safe, compassionate and equitable.

References

1. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):e001570.
2. NHS England. Accessible Information Standard (DCB1605/DAPB1605): Specification and Guidance. London: NHS England; 2016.
3. The Royal College of Ophthalmologists. Quality Improvement Framework for Ophthalmology. London: RCOphth; 2021.
4. Hrisos S, Clarke MP, Wright J. The emotional impact of amblyopia treatment in children and parents. Eye.2004;18(8):962–968.
5. Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83–90.
6. British Psychological Society. Paediatric Communication Guidelines. London: BPS; 2020.
7. Aspinal F, Hughes R, Dunckley M, et al. The Accessible Information Standard: action and reaction. Br J Gen Pract.2016;66(643):e292–e294.
8. Goleman D. Emotional Intelligence: Why It Can Matter More Than IQ. London: Bloomsbury; 1996.
9. Friedman CP, Rubin JC, Sullivan KJ, et al. Toward a science of learning systems: a research agenda for the high-functioning learning health system. J Am Med Inform Assoc. 2015;22(1):43–50.