Will the friends and family test transform the NHS?: The test is not another complaints system – it puts the voice and opinion of patients at the heart of the NHS
The friends and family test is not just another NHS data collection exercise. For the first time, the fundamental purpose of the information collected is to share it with the public in a totally open, transparent way.
When the prime minister announced the test, the focus was on giving patients information to help them choose, not providing yet more internal statistics for organisational improvement.
Paradoxically however it will become one of the most effective improvement tools the NHS has ever seen, one which puts continuous pressure on all organisations, which highlights excellence while shining the light of transparency onto sub-standard performance.
This power lies in core features of the test which, although commonplace outside healthcare, are unique for NHS quality and performance monitoring. The link between transparent user feedback and improved service quality is now well recognised, often solving the most intractable quality challenges. For instance, efforts over many years to reduce food infection in New York restaurants had no impact, until restaurant rating assessments were displayed on the window of every restaurant in full view of staff and diners.
So how will the test deliver these same benefits to the NHS?
Most importantly every patient will be asked for their opinion, not just occasional sampling. Traditional experience measurement (e.g. national patient survey) depends on intermittent questionnaires, distributed when the hospital chooses. The test changes all this – the patients choose what to say and when they say it rather than waiting to be asked. Every experience – good or bad – becomes a chance for patient feedback, giving the NHS a transformational opportunity to learn from the huge untapped resource that is the wisdom of patients.
Currently we make it difficult for patients to share perceptions with provider and professionals, and put up barriers preventing them from helping us learn and improve. The test removes these barriers.
Secondly, this continuous information will be fed back to frontline clinicians showing comparative performance. Every ward will be able to see exactly how well they perform in the eyes of the patients. Giving professionals simple metrics which lets them see performance compared to their peers (both local and national) has been shown to drive continuous improvement: the best want to stay at the top, and those shown to be lagging-behind improve what they do to close the gap.
The test will ensure that a report is sent to every ward, in every NHS hospital showing staff how they did last week and where they sit compared to other wards.
Thirdly, the vast majority of feedback and "recommend" ratings gathered from the friends and family test will be highly positive – grateful patients will use this as a way to thank those who cared for them and to reassure their peers of the quality of service. Over the four years that iWantGreatCare has been delivering real-time patient experiences (usually including a version of the "would you recommend …?" question), this has been a consistent finding. Done properly patient experience ("ratings and reviews") delivers overwhelmingly positive feedback.
Giving such feedback to hardworking teams improves morale, ensures continuous engagement of staff with the needs of patients, and builds a culture fully focused on ensuring excellence in patient experience.
But what are the risks of the test not delivering this impact, and becoming merely another data collection exercise?
The test is about openly sharing with the public the opinion and rating of other patients. This is at the heart of the approach, and indeed its power to drive change and improve quality.
For trusts (and their staff) to benefit from the FFT they must collect (and share with users) qualitative feedback – stories or reviews – as well as the single "would you recommend?" question. This is recognised in the latest DH guidance and is vital to understand why the patient would or would not recommend.
Finally, this is completely different to anything trusts have done before. It represents a seismic shift in process, attitude and concept of risk. It will lead to many fundamental changes and requires a new approach in trusts thinking about complaints systems, medico-legal issues and responding to patient concerns. If the NHS considers the friends and family test as just another data collection exercise then it will not succeed.
Done properly the test works, transforming culture, improving quality and providing a unifying, simple measure that everyone understands and can feed into.
The friends and family test is not another complaints system, it is not the NPS, and it is not a slimmed down national patient survey. It is putting the voice and opinion of patients at the heart of the NHS, it is about making the perception of patients the cornerstone of everything we do, and it is a huge opportunity for the NHS to set a global standard in healthcare transparency.
Dr Neil Bacon is founder and chief executive of iWantGreatCare, an organisation which is working with the NHS Confederation to implement the friends and family test for NHS trusts for free. Guardian Professional.
The friends and family test is not just another NHS data collection exercise. For the first time, the fundamental purpose of the information collected is to share it with the public in a totally open, transparent way.
When the prime minister announced the test, the focus was on giving patients information to help them choose, not providing yet more internal statistics for organisational improvement.
Paradoxically however it will become one of the most effective improvement tools the NHS has ever seen, one which puts continuous pressure on all organisations, which highlights excellence while shining the light of transparency onto sub-standard performance.
This power lies in core features of the test which, although commonplace outside healthcare, are unique for NHS quality and performance monitoring. The link between transparent user feedback and improved service quality is now well recognised, often solving the most intractable quality challenges. For instance, efforts over many years to reduce food infection in New York restaurants had no impact, until restaurant rating assessments were displayed on the window of every restaurant in full view of staff and diners.
So how will the test deliver these same benefits to the NHS?
Most importantly every patient will be asked for their opinion, not just occasional sampling. Traditional experience measurement (e.g. national patient survey) depends on intermittent questionnaires, distributed when the hospital chooses. The test changes all this – the patients choose what to say and when they say it rather than waiting to be asked. Every experience – good or bad – becomes a chance for patient feedback, giving the NHS a transformational opportunity to learn from the huge untapped resource that is the wisdom of patients.
Currently we make it difficult for patients to share perceptions with provider and professionals, and put up barriers preventing them from helping us learn and improve. The test removes these barriers.
Secondly, this continuous information will be fed back to frontline clinicians showing comparative performance. Every ward will be able to see exactly how well they perform in the eyes of the patients. Giving professionals simple metrics which lets them see performance compared to their peers (both local and national) has been shown to drive continuous improvement: the best want to stay at the top, and those shown to be lagging-behind improve what they do to close the gap.
The test will ensure that a report is sent to every ward, in every NHS hospital showing staff how they did last week and where they sit compared to other wards.
Thirdly, the vast majority of feedback and "recommend" ratings gathered from the friends and family test will be highly positive – grateful patients will use this as a way to thank those who cared for them and to reassure their peers of the quality of service. Over the four years that iWantGreatCare has been delivering real-time patient experiences (usually including a version of the "would you recommend …?" question), this has been a consistent finding. Done properly patient experience ("ratings and reviews") delivers overwhelmingly positive feedback.
Giving such feedback to hardworking teams improves morale, ensures continuous engagement of staff with the needs of patients, and builds a culture fully focused on ensuring excellence in patient experience.
But what are the risks of the test not delivering this impact, and becoming merely another data collection exercise?
The test is about openly sharing with the public the opinion and rating of other patients. This is at the heart of the approach, and indeed its power to drive change and improve quality.
For trusts (and their staff) to benefit from the FFT they must collect (and share with users) qualitative feedback – stories or reviews – as well as the single "would you recommend?" question. This is recognised in the latest DH guidance and is vital to understand why the patient would or would not recommend.
Finally, this is completely different to anything trusts have done before. It represents a seismic shift in process, attitude and concept of risk. It will lead to many fundamental changes and requires a new approach in trusts thinking about complaints systems, medico-legal issues and responding to patient concerns. If the NHS considers the friends and family test as just another data collection exercise then it will not succeed.
Done properly the test works, transforming culture, improving quality and providing a unifying, simple measure that everyone understands and can feed into.
The friends and family test is not another complaints system, it is not the NPS, and it is not a slimmed down national patient survey. It is putting the voice and opinion of patients at the heart of the NHS, it is about making the perception of patients the cornerstone of everything we do, and it is a huge opportunity for the NHS to set a global standard in healthcare transparency.
Dr Neil Bacon is founder and chief executive of iWantGreatCare, an organisation which is working with the NHS Confederation to implement the friends and family test for NHS trusts for free. Guardian Professional.
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