1. 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

2. 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

3. Background to FFT

4. 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)

5. 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

6. 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

7. 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

9. 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

10. 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

11. 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

12. 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

13. 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

15. 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

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

18. 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

20. 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