Many of Cemplicity’s clients and colleagues in Australia, New Zealand and Ireland look to the NHS as the exemplar of a patient centred health service. It was therefore with great excitement I packed up the family and moved to the UK to become both a patient of the system and to join the UK patient-reported measures industry.
As a patient, it’s evident in every interaction that we are partners in the system (even if services aren’t always easy to access). The right to express your opinion of a service is deeply ingrained. I’m sure the wide coverage of the Friends and Family Test (FFT) has cemented this active patient engagement.
The NHS put the FFT in place in 2013. That’s a long time ago in technology terms. Equally, much has been learned over the past five years about how best to use patient-reporting measures for service improvement. I’ve spent some time in recent months distilling what we have seen working well in other countries and looking into how this might help evolve the FFT into a first-class quality improvement tool for the next decade.
The Cemplicity team sees three main opportunities to improve the FFT’s impact, which I’ll expand on below and in a later blog. These are:
- (i) increasing the FFT’s reach while reducing staff involvement in capturing feedback,
- (ii) widening the scope of the feedback so the quantitative data is more useful and
- (iii) improving the timeliness of feedback so action can be taken quickly when opportunities for improvement exist.
Increasing the reach of the FFT
Enabling all patients to give feedback was central to the FFT’s design. However, this outcome has largely been achieved through the hard work of nursing and administration staff. I’m still amazed by the amount of paper used in the NHS, ranging from appointment letters to FFT surveys.
In 2018 and beyond, feedback mechanisms should be digitally led, i.e., by email or mobile. Tablets, paper and postcards should only be used for patients who are unreachable via email or SMS.
Such digitally led mechanisms are core to Cemplicity’s programmes in other countries and offer these six benefits:
- Wider reach for reliable results. Over time, you reach many more patients and build larger datasets, so results are reliable when filtered down to ward or service level;
- Reduced cost. Many of our programmes have proven only using email and mobile can often reach a representative group of patients. This reduces the cost of feedback programmes significantly compared with those using postcards and paper surveys extensively;
- Less administration. Staff administration is greatly reduced. Instead of time spent gathering feedback, data entry and reporting, staff can spend time on actual improvement;
- Better results. It enables you to reach hospital patients post-discharge, which leads to better quality results;
- Results can be skewed if staff are present during interviewing, but with digital mechanisms, you can capture patients’ feedback on discharge experiences and care coordination once they are home.
- Gathering feedback at least a week after discharge is proven to positively influence results because patients are less tired, emotional and affected by medication.
- Anonymity. Patients can better respond anonymously which encourages them to be more open;
- Faster feedback loop. Patient feedback reaches frontline staff within seconds rather than days or weeks. If a problem arises in a ward, clinic or service you want to know now – not after another 100 patients have been through the service.
(P.S. Interestingly, we still encounter practitioners who resist mixed-mode methodologies for data collection, concerned that each mode introduces bias. These concerns need to be weighed up against the facts that digital first programmes often cost less than half that of paper ones, they deliver more timely feedback and create larger datasets from which we can derive significant value. That said, we can see a useful research project on the horizon to robustly investigate the impact of different survey modes on results.)