1. 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

2. 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

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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

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

13. 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
NHS Improvement

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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
NHS Improvement

20. 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

21. 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

22. 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

23. 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

24. Next steps
NHS Improvement

25. 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

26. Resources
Updates and FAQs are available via our project web page
Sign up for our FFT monthly newsletter
Publication of the guidance will be accompanied by a fresh set of web pages on our website
Our case studies, recently refreshed, are here:
You can see the bite-size guides we have already published here:
Contact our Helpdesk,
NHS Improvement

27. Thank you
To contact us with a question or to join our NHS Insight Network: