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NHS Friends and Family TestNurses in Management and Leadership Conference

11th November 2014

Yvonne Franks, Head of Patient Experience and Quality, NHS England, London region

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This presentation will;

• Provide an overview of the Friends and Family Test (FFT)

• Advocate the advantages of real time patient feedback

• Consider the leadership characteristics and behaviours useful when using patient feedback for the benefit of staff and patients

• Provide tips for making FFT more inclusive and accessible to patients and their families

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Background to FFT

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Roll-outThe FFT puts the patient voice centre-stage in health service improvement. It has already been successfully introduced into A&E, inpatient and maternity services.

Further roll out dates are:

• From 1 April 2014 Staff FFT

• From 1 December 2014 GP Practices

• From 1 January 2015 Mental health and community services

• From 1 April 2015 NHS dental service providers, ambulance and patient transport services and acute hospitals outpatients and day cases.

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• Gather feedback from patients in near real time

• Provide a broad measure of patient experience that can be used alongside other data to inform patient choice

• Identify areas where improvements can be made so practical action can be taken

The primary aims of FFT are to;

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Principles of FFT• All people who use NHS services should have the

opportunity to provide real-time feedback on their experience.

• Feedback should be used to celebrate and build on what’s working well and identify where improvement could be made.

For patients;• The right to provide

feedback• Anonymity• Support to participate• Not cause distress

Operational;• Continuous• Simple process, low burden for

patients and organisations• Availability of results to patients

and public• Some mandatory elements and

some for local determination • Demographic data

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Context and implementation

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• FFT aims to provide a simple, headline metric, which when combined with follow-up questions can be used to drive cultural change and continual improvements

• The question; ‘How likely are you to recommend our ward / A&E department to friends and family if they needed similar care or treatment’

• 6 possible answers ranging from ‘extremely likely’ to extremely unlikely’

• Follow-up question asking for the reason for the score given

• Survey methodology; no mandated method – card systems to txt, i-pod and other technologies and kiosks

Extremely likely

Likely Neither

likely nor unlikely

Unlikely Extremely

unlikely Don’t know

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How are we doing?

• Responses received in 18 months?

Over 4 million• Comparison with national inpatient survey

Approx. 65,000 annually• Therefore we would wait over 60 years to receive as many

responses

But …• Survey statistically comparable, FFT is not• Near real-time feedback – increasing evidence of positive

impact on staff morale• Hundreds of examples where FFT feedback has resulted in

local improvements

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Strengths

• It gives every patient an opportunity to give feedback

• Staff receive feedback quickly and can make swift changes where improvements are needed and are motivated when they receive praise

• It is a mechanism for tracking service improvement over time within a Trust

• It gives a picture, alongside other data, of how a Trust is performing

‘FFT has had the biggest

single impact on improving care’

Chief Nurse and Director of Clinical Standards

FFT demonstrates good connectedness with patients. It highlights

problems at an early stage and enables patients to see

that we listen and act on what they say’

GP Practice Manager

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How has this been achieved?

• Compassionate leadership – at all levels• Staff engagement +++• Local delivery of a national vision

But …… what next?• Get to those we find hard to reach (perhaps those

we most need to hear from• Make sure service improvement is at the heart of

the process from beginning to end

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How do compassionate leaders behave?(from Action Area 4 Leadership Think Tank Nov 2013)

• Embrace 6Cs• Engage with staff at all levels• Understand culture & behaviours• Understand & know the people they are leading• Have a situational/flexible leadership style• Listening/empathy/consistency• High level of emotional intelligence• Persistent & resilient• ‘Feel’ the impact of compassionate leadership• Role model/credibility• Manage culture• Visibility – seen & heard• Active leadership• Positive – empowering others

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Compassionate Leadership

To know when FFT is not appropriate to ask

Make reasonable adjustments to make FFT inclusive

Explain its importance to patients and staff‘you said, we did’

To ask the patient or family you know are unhappy

Increase responses, identify themes and act on feedback

Lead by exampleConvince others it can make a difference

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What makes FFT inaccessible? We all know that FFT is inaccessible for some patients, ironically those we perhaps most need to hear from

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• Children and Young People• Miscarriage, stillbirth or neonatal

death• Learning Disabilities• Dementia• People with little or no English• People with low levels of literacy• People who are profoundly deaf or

use British Sign Language• People who are partially sighted• People who are Deaf blind• Patients in Secure Settings

accessing NHS services• Armed Forces Health

Mandatory elements• Standard question• 6 point answer• Only the patient to answer• At point of discharge or within 48hrs• Not asked by staff looking after the

patient (gratitude / vulnerability bias)

Solutions• Guidelines recommend adjustments to

ensure feedback is received from hard to reach groups

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‘The NHS commits to encourage and welcome feedback on your health and care experiences and use this to improve services’ (NHS Constitution 2013 pledge)

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What is the impact of compassionate leaders?

• Makes a difference• Creates an open culture where staff feel valued• Creates sustainable change• Resolves conflict without becoming personal• Improves quality outcomes

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In summary

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•This is an opportunity that must not be missed

•Vital analysis – the follow up questions provide qualitative

information

•Focus on service improvement using themes from results

•Involve and engage all patients

•Continuous feedback to patients and public

•Use it as a tool (with others) for continual quality monitoring

•Share good practice

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