26 / 08 / 2014
The friends and family test
Picker Institute, August 2014
Picker Institute Europe, a not-for-profit organisation that supports improvement of patient experience of health services through effective measurement and action on people’s feedback, has produced a policy briefing on the Friends and Family Test (FFT). The document summarises the history of what it describes as "the controversial test", which is based on the Net Promoter Score - a measurement of 'customer loyalty' based on whether a consumer is likely to recommend a product, service or company to a friend.
The briefing reminds readers that the FFT was launched by the prime minister with considerable fanfare two years ago, when he announced "We're going to give everyone a really clear idea of where to get the best care - and drive other hospitals to raise their game." (Prime Minister's Office, 2012).
The timing of Picker's document is linked to a review of the FFT by NHS England, and the briefing analyses whether the review and its recommendations go far enough to address concerns and criticism of the Test. The briefing examines the review’s findings, which concludes FFT is "most suitable as a tool for service improvement", and works best when it is part of a wider process for capturing patient feedback, embedded in a culture of patient-centred care, with the appropriate resources for delivery. It does not work well as "a robust survey tool" and consequently should not be used a basis for performance-related payments or inter-organisational comparison.
The authors describe where the NHS England review identifies areas in which FFT could and should be improved. The review "does not go far enough" in addressing public understanding of FFT, particularly around 'recommending' care to a friend or relative when the need for care may not be the result of an active choice. Picker supports a change to the test’s headline question, and says the NHS England review "stops short of considering [this] in detail".
The briefing concludes that the NHS England FFT review is "a welcome signpost" and "an important milestone". It also says the revisions proposed as a result are likely to improve the test's usefulness, but that a number of key questions remain outstanding about how it continues to be perceived as a measure of comparative quality between organisations. The briefing recommends that in order for the Test to be credible and valuable, there should be clearer expectations and "true clarity of purpose."