FRIENDS & FAMILY TEST XXXX
The NHS Friends and Family Test in primary care: making it useful
Stuart Mathieson has an Oxford MBA and a background as a clinician and director in the health service for 27 years. He founded CoMetrica, which measures patient experience and clinical outcomes. Here, he explores the potential channels for GP patient feedback.
Channel
Paper questionnaire issued at the practice reception, ‘put in the box’, returned to a third party for processing
Advantages • Modest cost
Disadvantages
• Only covers attendees • Frontline effort • Bias – possibly not all patients offered • Worry of anonymity • Much less likely to reflect that consultation
Paper questionnaire issued at the practice – returned to a third party by post afterwards
Paper questionnaire sent to patient’s home with paper or online completion returned to third party
• Greater confidence of anonymity
• Only covers attendees • Frontline effort • Bias – possibly not all patients offered • Higher cost
• Can cover all list not just attendees
• 100% equitable coverage • Most likely to elicit useful stories
Advertised online survey link • Lowest cost
Link given to patients on a card after consultation – similar to shop receipt schemes
In-practice tablet/kiosk • Low cost
• Minimal and biased reach • Effort of promotion
• Biased reach
• Likely to be forgotten with more important take-aways e.g. prescriptions
• ‘Seen to be doing something’ • Equipment investment & maintenance
• Physical space, location restrictions
• Only covers attendees • Frontline effort in promotion • Biased reach
• Worry of anonymity • Much less likely to reflect that consultation
• Minimal comments collected Emailed link • Low cost SMS text link (smartphones) • Lower cost
• Limited to those with known email addresses
• Limited to those with known mobile numbers
• Proportion not opened – seen as spam
SMS text interaction • Lower cost
• Limited to those with known mobile numbers
• Proportion not opened – seen as spam
• Less likely to complete more than two/three simple questions
Smartphone apps
• ‘Seen to be doing something’ • Low reach among elderly • How many will install an app to answer a question? • High cost to maintain and update
54 | national health executive Sep/Oct 14
In considering which channels to use for which patients, to be useful, the measurement must allow time for patient reflection of the whole process. Giving out forms to patients on arrival is most likely to only measure the patient’s perception of the speed of getting an appointment. To be able to measure the experience of the consultation and the effectiveness of the care provided, the channels used should allow for:
• Reflective measurement at home after the visit
• The input of carers and relatives where required
• The collection of comments and stories • Assured anonymity
Avoiding box ticking Where incentives are applied for response
• Higher cost
Let us take a typical GP practice list of perhaps 1,500 patients. Although this covers all age ranges, most regular contact with the practice will naturally be from those aged over 60, the parents of young children and expectant mothers. The balance is that the greatest list population by volume will be aged five to 60.
Almost all of these broad groups are capable of using online collection, but the approach for each group is significantly different. Think busy mums, people snatching some time away from work to visit the GP, those with long-term conditions, language and cultural barriers and the retired elderly. To reach all these and engage with them in a way in which they will readily respond requires the use of multiple methods or channels, each targeted to appropriate groups.
Time and place The effort of measuring O
ne of the main problems with patient experience measurement can be that
considerable time and effort is required by frontline staff to collect the responses from patients and process them. The effort is doing the measuring – not helped by incentives or requirements to measure rather than to act. In recent years, the advent of online collection has removed much of this effort, but replaces it with poor coverage and can skew the results – which are often ignored.
Getting equitable representation
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