We are a good hospital and our patients overwhelmingly recommend us, so why did the Family and Friends Test results place us among the worst trusts in the country? asks Helen Ryan
The Friends and Family Test concept is very simple: ask every patient in every hospital if they would recommend the service they have just experienced to a friend or family. It’s not difficult, a bit blunt as an instrument maybe, but worth doing.
I think the test is useful when used in conjunction with other sources of patient feedback. However, it shouldn’t be headline news on its own as it is a simple, limited tool that is a small piece of the jigsaw.
There has been a great deal of time, effort and media attention leading up to the test’s implementation in April this year. And this meant the publication of the first set of national results in July had fanfares and headlines guaranteed.
“Unfortunately, we had not factored in how the data would be “interpreted” by NHS Choices. This turned our good results into very bad results indeed”
I am the director of nursing at Yeovil District Hospital Foundation Trust in Somerset. We have an organisational culture called iCARE, which is held up as an example of good practice for staff and patient engagement, so the Friends and Family Test should have presented us with no problems.
We committed fully to the task of getting a good level of response to the survey from our inpatients. The lower benchmark was 15% and, with maximum effort from staff, we were getting up around the 40% mark, which was excellent.
As we were calculating our own results, we knew we were getting very positive endorsement (95%) from our patients. While we were not complacent, we were quietly confident - and why not?
Unfortunately, we had not factored in how the data would be “interpreted” by NHS Choices. This turned our good results into very bad results indeed.
The first main issue is the use of a net promoter score (NPS). This is basically a calculation applied to the survey figures that gives a single number score rather than percentages. Applying NPS methodology to the Friends and Family Test has been controversial and it certainly could be blamed for muddying the waters.
Putting that to one side, every NHS provider now has an NPS against their results and ours was 66 for June, which - apparently in NPS world - is a good score.
The second key issue is that the list of hospitals with their NPS scores are given to NHS Choices so it can display a rating for each organisation.
Now NHS Choices is wedded to its methodology of providing an indication of how one organisation performs relative to another. Everyone goes on a list, with the top 20% rated as “among the best”, the middle 60% as “OK” and bottom 20% as “among the worst”, complete with a cautionary warning red exclamation mark.
My view is that NHS Choices was caught out by the fact that a high proportion of trusts scored very well. This meant the bottom 20% had many trusts like ours, which had good scores, but it still rigidly stuck to its chosen format. And so our Friends and Family Test bombshell was dropped.
The local paper displayed the alarming headline that the survey placed us among the worst trusts in the country. BBC radio interviews followed. Patients and our local population were justifiably alarmed and staff were angry and disillusioned.
We are a good hospital and our patients overwhelmingly recommend us, so my question is: why did the NHS over complicate a simple survey and end up misrepresenting the results?
The opportunity of celebrating a legitimate good news story that might restore some confidence in the NHS as well as recognise the hard work of our staff has been squandered and frankly, in my opinion, that’s indefensible.
Helen Ryan is director of nursing and clinical governance at Yeovil District Hospital Foundation Trust