Toby Knightley-Day: 'Nurses should take ownership of the Friends and Family Test'
Managers and frontline staff must start talking about the Friends and Family Test now, says Toby Knightley-Day
The Friends and Family Test (FFT) will ask accident and emergency and overnight inpatients whether they would recommend the services to their friends and family. In political circles it marks a step towards giving patients a meaningful voice and rewarding successful providers; for detractors, it has limitations - particularly its ability to deliver practical feedback. While there may be truth in both arguments, the longer people continue to rail against the measure, the less chance we have to make the compulsory FFT work for the NHS.
Criticism has focused on the score element of the test. To some degree this is understandable. Although a comparable score will allow the centre to measure system performance, in the past this has led to bureaucracy and little feedback for the frontline. It’s worth noting that in its original form, the FFT was a score linked to a text justification for that score. The problem is the government’s guidelines have allowed trusts the option of dropping this qualitative element, potentially leaving them with just a headline performance measure. For this reason, trust managers and frontline staff must start talking about the FFT now.
“It’s because nurses play a vital role in patient care that they are the key to the FFT’s success”
Andrew Frazer, chair of the RCN Emergency Care Association, said recently that the FFT represented another stick with which to punish staff. This was followed by comments by Sally Brearley, chair of the Nursing and Care Quality Forum (on whose recommendation the FFT was introduced), who rightly warned against focusing FFT results entirely on nurses (news, page 2, 4 December 2012). Both concerns stem from the same avoidable issue: implementing a score-only test. In this system, nurses will bear the brunt of complaints because they deliver the majority of hands-on care. Take, for example, the patient who waits hours for transport but is otherwise happy with their experience - their low score cannot be attributed to any specific cause, and it’s possible that the quality of care will become the scapegoat. If trusts decide against collecting qualitative feedback to explain scores, wards will be unable to deflect attention to the part of the system that is failing. Similarly, trust managers cannot hope to improve their scores if they cannot monitor and oversee improvement.
Instead of resisting, nurses could take ownership of the initiative. Although existing surveys feed into service development and policy, none connects individual experience with point of service in a way that encourages behaviour and culture change. If we let it, the FFT can bridge this gap. It’s because nurses play a vital role in patient care that they are the key to the FFT’s success. Own the measure, take pride in the scores, and strive to improve service according to patient feedback, and the NHS will benefit. Allow it to be an intrusive management tool that fails to empower you to make changes, and nothing positive will come from the compulsory investment.
By April, acute and emergency services will need to be operating the FFT. That means fewer than three months to decide on a format, appoint a provider, train staff and iron out issues. To get anything from the test, we must forget the aggregated score and encourage staff to use it to empower themselves. To do so, they must insist on a complete version of the test, including free text. Ward teams must set objectives and values, and should use feedback to ensure they meet them. Managers should then use qualitative data to reward success or identify issues and apply appropriate action. Only then can the test be more than a box-ticking exercise. Only then can we make timely interventions when care fails, or reward staff for going above and beyond expectations.
Toby Knightley-Day is managing director of Fr3dom Health (a provider of patient experience solutions)
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