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OPINION

Paul Snelling: 'Can you explain the Friends and Family Test results to patients?'

  • 4 Comments

The Friends and Family Test has been implemented in the face of evidence from users showing that it is manifestly unsuitable, says Paul Snelling

While asking students to complete the National Student Survey, I was reminded that similar surveys are undertaken in hospitals through the Friends and Family Test. This asks: “How likely are you to recommend our ward to friends and family if they needed similar care or treatment?” The answer is given on a five-point Likert scale, the responses going from “extremely likely” to “likely” through to neutral and then negative responses.

Part of my pitch to students was to try to convince them we want their views, and are willing to consider changing what we do as a result of what they say. Responding to evaluations and reshaping (local) services as a result is an important part of public service and professional practice, an ethos that became lost when some hospitals and individuals (but many leaders) lost their purpose. Re-engaging in honest conversation with those we serve is one way of refocusing and rebuilding relationships. Who could possibly object to that?

“It is ironic that the government has ignored the public’s views about a test designed to establish the public’s views and aid their decision making”

My objection is not so much to the intention but the way it has been implemented. The Friends and Family Test is based on a method of measuring customer satisfaction, developed in the US as a way of identifying the potential for small business growth. It’s fair to say the evidence for its success in this enterprise is at best mixed, and yet it has been transported across the Atlantic and implanted into a very large public service organisation. The test uses complicated analysis that counts the number of “extremely likely” responses, ignores the “likely” ones, and subtracts all the others before calculating an overall score, which appears on websites the public is invited to use to make treatment choices.

Two reports commissioned by the Department of Health, from the Picker Institute and IPSOS Mori, found the test unsuitable. Both conducted research with the public who reported that the question was difficult to understand. The IPSOS Mori report (available on the DH website) makes particularly interesting reading.

The public roundly rejected the method of analysis because they didn’t understand it. However, there was support from professionals, some of whom said that it didn’t matter that the public didn’t know how the scores were calculated - they only needed to know what the scores were, which looks to me very much like the exclusive attitudes that the scores are partly intended to overcome. IPSOS Mori also disagreed, suggesting the public will inevitably ask for details about how the scores are calculated.

Glossy leaflets for staff and patients don’t mention it and neither does the NHS Choices website, where patients are encouraged to view scores. There is a link to the implementation guidance. It is 29 pages long, but there’s no explanation here either.

If a student asks me how the National Student Survey scores are calculated, I can answer easily; a simple percentage of people agreeing with statements. My challenge to nurses reading this is to ask whether you are equally confident in explaining Friends and Family Test results to patients. I suspect many are not, but that even if you are, most patients still will not understand it.

It is ironic that the government has ignored the public’s views about a test designed to establish the public’s views and aid their decision making. I hope nurses will engage with patient feedback constructively for the right reasons and not be put off by a test implemented in the face of evidence from users showing that it is manifestly unsuitable. I will do the same with the National Student Survey, but it’ll be a lot easier; and if any students are reading this, please do complete the survey. We really do want to know what you think.


● Go to http://www.thestudentsurvey.com

Paul Snelling is senior lecturer in adult nursing at the University of Worcester

  • 4 Comments

Readers' comments (4)

  • michael stone

    'Both conducted research with the public who reported that the question was difficult to understand.'

    It is the wrong test anyway: you should be asking 'Tell us if you were happy or unhappy with your experience, and WHY'.

    Asking 'and explain why' draws out the detail - which you need to improve the service - but makes the feedback almost inpossible to easily 'measure'. So we [public] are lumbered with a feedback method that is easy to process' and easy to 'compare across hospitals', but which isn't actually very useful for service improvement.

    The NHS is obsessed with 'easy to audit' !

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  • The FFT is an entirely inappropriate way to gather feedback from patients and carers on their care experience. On several occassions I've seen it used by patients, carers and relatives alike as a passive aggressive stick with which to beat nursing and medical staff. For example, when one visitor was asked not to use the patients kitchen to make himself a cup of coffee, he immediately picked up an FFT and proceeded to give the ward scathing feedback.
    In addition, it is concerning that there is no way to ensure that feedback is sought from the appropriate people. Anyone can pick up a FFT and drop it in the box, so to my eye it's questionable how valuable FFT feedback can be, and whether it is appropriate to use it's findings to change services.

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  • I work in A&E and I'm not convinced that the Friends & family Test is relevant to my area. Asking someone if they would reccomend a service which they would rather not have to use in the first place is bad enough and patients who are brought to A&E by ambulance invariably have no choice whatsoever. This, combined with the target to collect a minimum number of responses makes it all seem like a bit of a merry go round. Maybe some qualitative interviews with patients would help us understand what patients really want?

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  • michael stone

    Anonymous | 7-Apr-2014 3:13 pm

    'In addition, it is concerning that there is no way to ensure that feedback is sought from the appropriate people.'

    It isn't easy to select for 'appropriate people' - but you definitely shouldn't have 'selection by the staff' or else they are likely to select people they suspect woudl provide 'positive' feedback.

    But to an extent, this should be a comparative exercise, anyway: irrespective of how many 'disgruntled moaners' complain, if a ward is getting 4 times as many complaints as the 'national average [for that type of ward]' then you might reasonably conclude it is doing something [differently], that upsets more patients.

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