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Next April – the NHS as global leader in transparency

November 27, 2012

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 – and this is the genius and power of the FFT – 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 whilst shining the light of transparency onto sub-standard performance.

This power lies in core features of the Test which, although common-place outside healthcare, are unique for NHS quality and performance monitoring. The link between transparent user feedback and improved service quality are 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 – despite increasing amounts of regulation and inspection. The single change that dramatically reduced food poisoning was when restaurant ratings were used not as an internal tool, but when – by law – the assessments were displayed on the window of every restaurant in full view of staff and diners.


So how will the the Test deliver these same benefits to the NHS, and why am I so confident that it is a dramatic and powerful force for good?

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 – now when feedback is provided, depends on the patient. 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, thereby giving the NHS a transformational opportunity to learn from the huge untapped resource that is the wisdom of patients. Every month millions of patients experience the NHS and have an insight about the service. Currently we fail to learn from that, 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, understanding what those they cared for last week thought of the service. 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. This changes everything.

Thirdly, is that the vast majority of feedback and “recommend” ratings gathered from the Friends and Family Test will be highly positive – grateful patients using this as a way to thank those who cared for them, and using it as a way to reassure their peers of the quality of service. Over the four years that iWantGreatCare has been delivering real-time patient experience systems (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 hard-working 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 all the time.


But what are the risks of the Test not delivering this impact, and becoming merely another data collection exercise?

It’s not the Net Promoter Score! As outlined above, the Test is about openly sharing with the public the opinion and rating of other patients. This is the heart of the approach, and indeed its power to drive change and improved quality. The NPS is very different – an internal management tool from industry, the purpose of which is to inform system change. A number of hospitals still seem to think that the FFT is “son of NPS”. No, NPS is dead in the NHS, long live the Friends and Family Test!

The power of stories. 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. Moreover, it is the human stories, in the patients’ words that engage staff and enable real focus on continuous improvement.

Finally, this is completely different to anything Trusts have done before. Continuously collecting huge volumes of quantitative and qualitative data and then openly sharing this in real time with both staff and patients represents a seismic shift in process, attitude and concept of risk. It will lead to many fundamental changes (that of course is the whole point!) 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.

The lessons learnt in four years of delivering such services are hugely encouraging.

1. Done properly it works, transforming culture, improving quality and providing a unifying, simple measure that everyone understands and can feed into.

2. Devices, tablets and gadgets are not the answer and waste money. In some settings (paediatrics, obstetrics for example) it can be an effective way to collect feedback but, working with a range of NHS Trusts for the last four years, it is absolutely clear that most regret spending money on technology boxes that never deliver the volumes of feedback required.

3. Doctors and nurses get as passionate and involved about this as do patients and managers. Patient experience is something that everyone who works in the NHS cares about and when it is measured and shared in real-time it builds a culture truly obsessed with giving every patient the best, each and every time.

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.


iWantGreatCare is offering NHS Trusts a complete Friends and Family service free of charge for three years:

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