It’s a fascinating experience to become a patient of a different health system. Having recently moved to the UK from New Zealand, I’ve discovered this first hand.
The pride UK citizens have in the NHS was apparent in the last Olympic Games. I’ve never come across a public institution so valued by its people. Perhaps reflecting this close relationship, the NHS was one of the first health systems globally to recognise the importance of patients’ experiences of care, and that systematic patient feedback can result in harm reduction and improved outcomes.
The Friends and Family Test
The NHS introduced the Friends and Family Test (FFT) in 2013 in response to a public inquiry into Mid-Staffordshire NHS Trust, which highlighted many deaths could have been prevented if the Trust had listened to patients and their families.
Like the Net Promoter Score (NPS), the FFT is a single question asking patients how likely they are to recommend healthcare providers to friends and family. The FFT has had over 48 million patient survey responses since its launch.
From talking to people across the sector, my conclusion is that the value of FFT isn’t derived from patients’ ratings. Despite the high volume of feedback, ratings have proven neither reliable for benchmarking nor useful drivers for improvement. Instead, it’s the patients’ comments accompanying ratings that drive change.
Many inquiries into health sector failures have shown patients’ stories often provide a better picture of service quality than performance ratings and statistics. A June 2018 report, the Gosport War Memorial Hospital: The Report of the Gosport Independent Panel, found over 450 avoidable deaths directly resulted from staff administering opioids without proper clinical indication between 1988 and 2000. A key outtake of this report was that authority figures constantly let down relatives who complained about patients’ safety and the appropriateness of their care.
The Patient Experience Library’s recent blog states: “Gosport must – surely – be the point at which dismissal of patient feedback as “anecdote” finally comes to an end.”
The same blog points out that, in the case of the Mid-Staffordshire NHS Trust failures, patient stories better reflected the truth than hard measures. While the Trust Board’s focus on key performance indicators showed steady progress towards Foundation status, “it was patients and relatives, with no statistics, no performance data, and no research methodology, who got much closer to the truth of what was happening on the wards,” the blog states.
Still, we frequently encounter health sector stakeholders who insist statistics and quantitative data should be the sole basis for performance measurement and decision making.
My next blogs will reflect on how we can build on the FFT’s strength – which is the wide capture of patient stories – and make better use of robust statistics. Our international experience has shown opportunities exist to refresh the FFT approach. This would reduce the load on staff while having a stronger impact on improved patient experiences.
I look forward to hearing your ideas and comments as we share our ideas in the following two blogs.