Clare Enston Head of Insight and Feedback Insight and Feedback Team PEN regional events 2019 Clare Enston Head of Insight and Feedback Insight and Feedback Team NHS Improvement

Clare Enston Head of Insight and feedback Insight and Feedback Team “You will find only what you bring in” Clare Enston Head of Insight and feedback Insight and Feedback Team NHS Improvement

…that retains the original idea A new look FFT…. …that retains the original idea NHS Improvement

You said / patients said… The question doesn’t make sense We have to amend the question so that it’s more accessible The question has to be explained to patients The question actively puts people off NHS Improvement

We have changed the question: Thinking about [x setting]… Overall, how was your experience of our service? [ ] Very good [ ] Good [ ] Neither good nor poor [ ] Poor [ ] Very poor [ ] Don’t know Cognitively tested with patients including CYP and those with a Learning Disability NHS Improvement

You said… The free text question doesn’t give us much information that we can use for improvement.. There’s a lot of “thank yous” NHS Improvement

We have changed the recommended free text questions: Please can you tell us why you gave your answer? Please tell us about anything that we could have done better NHS Improvement

You said… We want to increase our response rate.. But are struggling to meet the “by 48hours” requirement in inpatients and A&E and complete the right checks.. We want to be able to ask people at different times – the policy doesn’t fit with what we think will work best for our patients NHS Improvement

We have removed the 48hour requirement Patients should be able to give feedback when they want to Teams can choose to ask proactively You can decide when this is This is in line with the model in Outpatients, Mental Health, Community & Primary Care services NHS Improvement

You said / women said… We’d like to give feedback when it works for us The current timing doesn’t work for women using our services The timing is too late for feedback on antenatal services We still need to be able to identify which part of the pathway the feedback relates to We’d like to give feedback when it works for us NHS Improvement

We have changed the maternity model Women should be able to give feedback when they want to Teams can choose to ask proactively You can decide when this is We suggest giving women 2 weeks after birth to respond about birth Use the framing text to relate feedback back to the relevant stage of maternity pathway This is in line with the model in Outpatients, Mental Health, Community & Primary Care services, Inpatients and A&E NHS Improvement

Patients said… There’s a lot going on in our minds when you ask us to give feedback. It’s not straightforward NHS Improvement

My state of health NHS Empathy Type of feedback – positive/negative/neutral Topic Moment feedback is given or asked for Care setting Authorship and anonymity My state of health NHS Empathy www.england.nhs.net NHS Improvement

So let’s be mindful of the psychology of giving feedback Asking in the moment, as care in happening At routine intervals for those with ongoing care needs – before discharge or if not being discharged At discharge from the service ie the current model Within a given timeframe (eg 1 week, 2 weeks) after discharge or after an intervention All are valid approaches; all have considerations NHS Improvement

Tell patients what changes have been made using their feedback; set out who will listen to what they say Patients said… We’re more likely to give feedback if we know what’s happening to it.. Is anyone listening to it? Does it make any difference? NHS Improvement

Data users said… We’ll continue to publish data on a monthly basis We still need to get the data and see it on a regular basis NHS Improvement

There’s too much focus on meeting a high response rate We’ll stop publishing response rates We’ll focus on FFT being a conversation starter around listening to patients and taking action on what’s heard as part of broader quality improvement work You said… There’s too much focus on meeting a high response rate NHS Improvement

We need the data to retain comparability Some said… The data are not comparable It’s not fair to staff to compare data with FFT data from other trusts If comparison is needed – look to other sources eg annual patient surveys Use FFT to monitor what happens in between those data points The numerical data has two key uses: Providers can use their own data as an informal temperature check, and look at change over time - looking at trends and anomalies Commissioners and regulators can use it alongside other information to get a picture of how engaged the provider is with its patients We need the data to retain comparability NHS Improvement

We’ve emphasised the best way to use the numerical data – Making Data Count Easy to follow guidance, includes an analytical technique called Statistical Process Control (SPC) SPC can show: where something is deteriorating or improving how capable a system is of delivering a standard or target if a process that we depend on is reliable and in control By recognising which type of variation you are dealing with, you can take the best action to deliver improvements https://improvement.nhs.uk/resources/making-data-count/ NHS Improvement

Plot the FFT dots Single point above the process limit Points following a decreasing trend If you find special cause variation, you need to investigate what is going on. This may be deteriorating performance which you need to understand and then take action to resolve. It may be an improvement which you need to learn from and sustain or spread to other parts of the organisation. Consecutive points above or below mean NHS Improvement

Frequently asked questions… YES! Can we add extra questions? YES! Should we capture some demographic information? Can we add colours / graphics / smiley faces to the question? Can carers/ relatives / visitors fill it in? YES! YES! NHS Improvement

Frequently asked questions… Is it compliant with GDPR? Can we offer a further conversation to patients if they leave their details? YES! YES! Can we use it for broader purposes? YES! NHS Improvement

You said / suppliers said… It’d be good to have a 6 month lead in time to prepare for the changes If we’re using digital eg tablets- it might take a few days to sync up to make the changes OK OK NHS Improvement

Next steps NHS Improvement

Can you help us make sense of all the free text comments we receive Further requests… Can you help us make sense of all the free text comments we receive Can you help us make sense of how to triangulate this data with other sources? YES! YES! NHS Improvement

Resources Updates and FAQs are available via our project web page www.england.nhs.uk/fft/friends-and-family-test-development-project-2018-19/ Sign up for our FFT monthly newsletter Publication of the guidance will be accompanied by a fresh set of web pages on our website www.england.nhs.uk/fft/ Our case studies, recently refreshed, are here: www.england.nhs.uk/fft/friends-and-family-test-development-project-2018-19/case-studies/ You can see the bite-size guides we have already published here: www.england.nhs.uk/publication/bite-size-guides-to-patient-insight/ Contact our Helpdesk, email: england.friendsandfamilytest@nhs.net NHS Improvement

Thank you To contact us with a question or to join our NHS Insight Network: england.insight-queries@nhs.net