Objective Online patient feedback is becoming increasingly prevalent on an international scale. However, limited research has explored how healthcare organisations implement such feedback. This research sought to explore how an acute hospital, recently placed into ‘special measures’ by a regulatory body implemented online feedback to support its improvement journey. Methods Semi-structured interviews were conducted with eleven key stakeholders involved in the implementation and/or use of online patient feedback. Data was analysed using deductive thematic analysis with Normalisation Process Theory used as the analytical framework. Research findings are translated into the Engage, Support and Promote (ESP) model, a model of rapid feedback adoption. Results Participants viewed the implementation of online feedback as an opportunity to learn, change and improve. Factors found to facilitate implementation were often linked to engagement, support and promotion. Although less frequently described, barriers to implementation included staff anxieties about time pressures, moderation processes and responding responsibilities. Such anxieties were often addressed by activities including the provision of evidence based responder training. Overall, staff were overwhelmingly positive about the value of online feedback with 24 impacts identified at an individual and organisational level, including the ability to boost staff morale, resilience and pride. Conclusions The rapid implementation of online patient feedback can be achieved in a ‘special measures’ organisation. However, the difficulties of implementing such feedback should not be underestimated. In order to embed online feedback, staff members need to be engaged and feel supported, with opportunities to provide, respond and invite patient feedback frequently promoted to both patients and staff members.

QUALITY AND safety of care commitments are embedded in the NHS Constitution for England (Department of Health 2015), which states that patients 'have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality'. Delivering this legal right to the public requires a considerable and continual focus on behalf of the workforce every day. Reducing patient harm and patient mortality are further drivers for robust safety and quality measurement, as well as for effective reporting processes across healthcare organisations (Morris 2012). Over the past decade, nurse managers have made significant efforts to use improvement methodology to translate knowledge into action and deliver measurable assurance of quality and safety of care. The structures put in place are now becoming pillars of trust board assurance frameworks. One such structure is ward accreditation programmes, which are promoted by the chief nursing officer for England in the Guide to Developing and Implementing Ward and Unit Accreditation Programmes (NHS Improvement 2019). This guide is targeted at chief nurses and Citation Underwood F, Dickinson L, O'Keeffe K et al (2020) Strengthening quality assurance by implementing an evidencebased revision of a ward accreditation programme. Nursing Management.