NHS Friends and Family Test Nurses in Management and Leadership Conference 11th November 2014 Yvonne Franks, Head of Patient Experience and Quality, NHS England, London region

This presentation will; Provide an overview of the Friends and Family Test (FFT) Advocate the advantages of real time patient feedback Consider the leadership characteristics and behaviours useful when using patient feedback for the benefit of staff and patients Provide tips for making FFT more inclusive and accessible to patients and their families

Background to FFT

Roll-out The FFT puts the patient voice centre-stage in health service improvement. It has already been successfully introduced into A&E, inpatient and maternity services. Further roll out dates are: From 1 April 2014 Staff FFT From 1 December 2014 GP Practices From 1 January 2015 Mental health and community services From 1 April 2015 NHS dental service providers, ambulance and patient transport services and acute hospitals outpatients and day cases. Unlike implementation in other services, we are not requiring the FFT question to be asked after every appointment. This is to avoid patients being asked routinely when they may have numerous appointments within a short period. Instead, the practice should make the opportunity available, and make sure patients know they can use the FFT to provide feedback if they want to. Experience with acute settings is that the majority of responses have been positive, and an important boost to staff morale. At the same time, many issues have been identified that providers have been able to address. Our intention is for the implementation to be as low a burden as possible on both providers and patients. There are a small number of mandatory requirements, but where possible we are allowing practices flexibility (such as choice of collection mode – e.g. postcards, SMS etc)

The primary aims of FFT are to; Gather feedback from patients in near real time Provide a broad measure of patient experience that can be used alongside other data to inform patient choice Identify areas where improvements can be made so practical action can be taken

Principles of FFT All people who use NHS services should have the opportunity to provide real-time feedback on their experience. Feedback should be used to celebrate and build on what’s working well and identify where improvement could be made. For patients; The right to provide feedback Anonymity Support to participate Not cause distress Operational; Continuous Simple process, low burden for patients and organisations Availability of results to patients and public Some mandatory elements and some for local determination Demographic data

Context and implementation FFT aims to provide a simple, headline metric, which when combined with follow-up questions can be used to drive cultural change and continual improvements The question; ‘How likely are you to recommend our ward / A&E department to friends and family if they needed similar care or treatment’ 6 possible answers ranging from ‘extremely likely’ to extremely unlikely’ Follow-up question asking for the reason for the score given Survey methodology; no mandated method – card systems to txt, i-pod and other technologies and kiosks Extremely likely Likely Neither likely nor unlikely Unlikely Extremely unlikely Don’t know

How are we doing? Over 4 million Approx. 65,000 annually Responses received in 18 months? Over 4 million Comparison with national inpatient survey Approx. 65,000 annually Therefore we would wait over 60 years to receive as many responses But … Survey statistically comparable, FFT is not Near real-time feedback – increasing evidence of positive impact on staff morale Hundreds of examples where FFT feedback has resulted in local improvements

FFT has had the biggest single impact on improving care’ Strengths FFT demonstrates good connectedness with patients. It highlights problems at an early stage and enables patients to see that we listen and act on what they say’ GP Practice Manager It gives every patient an opportunity to give feedback Staff receive feedback quickly and can make swift changes where improvements are needed and are motivated when they receive praise It is a mechanism for tracking service improvement over time within a Trust It gives a picture, alongside other data, of how a Trust is performing ‘ FFT has had the biggest single impact on improving care’ Chief Nurse and Director of Clinical Standards

How has this been achieved? Compassionate leadership – at all levels Staff engagement +++ Local delivery of a national vision But …… what next? Get to those we find hard to reach (perhaps those we most need to hear from Make sure service improvement is at the heart of the process from beginning to end

How do compassionate leaders behave How do compassionate leaders behave? (from Action Area 4 Leadership Think Tank Nov 2013) Embrace 6Cs Engage with staff at all levels Understand culture & behaviours Understand & know the people they are leading Have a situational/flexible leadership style Listening/empathy/consistency High level of emotional intelligence Persistent & resilient ‘Feel’ the impact of compassionate leadership Role model/credibility Manage culture Visibility – seen & heard Active leadership Positive – empowering others

Compassionate Leadership To know when FFT is not appropriate to ask Make reasonable adjustments to make FFT inclusive Explain its importance to patients and staff ‘you said, we did’ To ask the patient or family you know are unhappy Increase responses, identify themes and act on feedback Lead by example Convince others it can make a difference

What makes FFT inaccessible What makes FFT inaccessible? We all know that FFT is inaccessible for some patients, ironically those we perhaps most need to hear from Children and Young People Miscarriage, stillbirth or neonatal death Learning Disabilities Dementia People with little or no English People with low levels of literacy People who are profoundly deaf or use British Sign Language People who are partially sighted People who are Deaf blind Patients in Secure Settings accessing NHS services Armed Forces Health Mandatory elements Standard question 6 point answer Only the patient to answer At point of discharge or within 48hrs Not asked by staff looking after the patient (gratitude / vulnerability bias) Solutions Guidelines recommend adjustments to ensure feedback is received from hard to reach groups

‘The NHS commits to encourage and welcome feedback on your health and care experiences and use this to improve services’ (NHS Constitution 2013 pledge)

What is the impact of compassionate leaders? Makes a difference Creates an open culture where staff feel valued Creates sustainable change Resolves conflict without becoming personal Improves quality outcomes

In summary This is an opportunity that must not be missed Vital analysis – the follow up questions provide qualitative information Focus on service improvement using themes from results Involve and engage all patients Continuous feedback to patients and public Use it as a tool (with others) for continual quality monitoring Share good practice