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Cheryl Swan: 'Friends and Family Test omits to tell us what needs to be fixed'


At our 40-bed rehabilitation unit in Blackpool, a few patients dislike our food. Others find our toilet roll dispensers hard to use, wish they could have more help with their exercises or long for more quiet time away from the wards.

We get wonderfully positive feedback, too - one patient laughingly told me our unit was like Shangri-La. The point is that we know all this because we ask patients to tell us what they think.

Now consider the Friends and Family Test. If a patient responds that they wouldn’t recommend a hospital or ward to a friend or member of the family, wouldn’t you want to know why? Jocelyn Cornwell, director of the Point of Care Foundation, hit the nail on the head when she said: “If someone responded negatively, we don’t know if it is because they had trouble with car parking or received poor care.”

What’s the point of yet another quantitative league table that produces impressively large statistics (400,000 patients questioned) but fails to address individual patient concerns? How can we start to make positive changes if we don’t even know what they should be?

At Spiral Health, we have complemented traditional tick-box questionnaires with an innovative approach to patient feedback called Working Together for Change (WTFC), introduced to us by personalisation expert Helen Sanderson. We’ve been using this to gather feedback from patients and make some positive changes. If you tell us your bed is too hard, we do something about it. If you are worried about the care you are receiving, we’ll work with you to fix the issue.

WTFC is structured into a series of eight steps. It sounds lengthy, but is very straightforward. We begin by interviewing patients, then a panel of people representing our hospital community meets to analyse this information. Our panel includes managers, healthcare assistants, therapists, nurses and patients. Every member has an equal voice and the WTFC process ensures all issues raised are carefully considered from all perspectives.

Patient interviews are conducted at bedsides about half-way through each patient’s stay. I prefer to think of these as chats, as the process is very relaxed. Each patient is asked to tell us about two things that are working, two things that are not working and two changes they would like to see in the future, if they came back to the unit again. This process is light years ahead of traditional patient surveys which just ask for yes or no answers.

The concerns raised vary hugely. Food is a perennial issue. We also learned that some patients needed their exercise regimes to be explained more fully and others were frustrated that bells weren’t being answered on the wards. As a result, we have made significant changes to our menu, personalised our exercise regimes and implemented a policy of zero tolerance on unanswered bells - along with tackling many, many other issues.

I’m very aware that many of our patients are older and come from generations where you didn’t speak up as you didn’t want to be labelled as a complainer. So our approach is that no issue is too small to be considered. If one patient is worried about something, others are probably anxious about it too.

After six months of using the WTFC process, traditional approaches to patient surveys are feeling a little pointless. And the Friends and Family Test? If it’s just another tick-box exercise, is it really worth the paper it is written on?

● Working Together for Change in a Hospital, a paper by Spiral Health with Helen Sanderson Associates is free to download from


Cheryl Swan is clinical director of social enterprise Spiral Health


Readers' comments (3)

  • I've said that before - you need a narrative response, explaining what it was that was being criticised or praised, if you actually want to learn from the feedback.

    The NHS/Goverment is obssessed with 'the easily comparable/auditable' as usual, not with the genuinely useful.

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  • michael stone

    The previous comment was by Mike Stone - I have no idea why it posted as anonymous, I certainly did not tick that box.

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  • 'personalisation expert' - heard it all now....

    'policy of zero tolerance on unanswered bells' - obviously not enough staff around if people feel they are not responded to promptly. Or is there an element of patient perception of rehab staff doubling up as 'bell hop?'

    Narrative feedback works a treat but not when some points are not reported more fully or expanded upon to answer specifics.

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