Friends & Family Test: The end of ‘Net Promoter’

Source: National Health Executive Jan/Feb 2015

NHE caught up with Andrew MacPherson, managing director of The NHS Strategic Projects Team, to discuss recent changes to the Friends & Family Test, following our last conversation with him in October.

When NHE last spoke to Andrew MacPherson, we highlighted the challenges and opportunities that the Friends & Family Test (FFT) was bringing to both NHS providers and commissioners, following the roll-out of the test across secondary care on behalf of NHS England and the Department of Health last year.

Since then, FFT has been introduced across primary care: within GP surgeries in December, and across mental health and community health services from the beginning of this year, with a planned extension to include dental services and acute outpatients from April 2015.

Changes in the scoring system

So how is it going? “The biggest change since we last spoke has probably been the shift from Net Promoter scoring to a ‘recommended percentage’ score,” MacPherson said. “The original question and the six response categories are, however, unchanged. This has meant that the range of scores are now much narrower than was seen before.

“Whilst FFT was never intended to be just about the score – much more about driving a cultural change and organisational development across the NHS – it has meant that the granularity of the reported progress is even more compressed.

“For example, the latest result under the new scoring system has meant that the lowest scoring provider of inpatient services in the country returned a result of 80.3%.

Whilst this method of scoring is still based on every respondent who would recommend the service, it does not offer much headroom for reported improvement. The Net Promoter score equivalent would have been calculated as 35 (over a scale of -100 to +100).

“Whilst we always intended the mechanism to be one for ‘catching people doing things right’, a little competitive tension and room for manoeuvre never did any harm towards aspiring to continuous improvement. Other sectors have used Net Promoter score to huge advantage in terms of productivity and service experience.

“The revised percentage scoring system still shows that the overwhelming number of responders would recommend the treatment and care that they had received. In November, the average score for the acute patients across England was 95%: a massive endorsement of NHS care, whichever way it’s calculated. However, the difference between the lowest and highest scores across the country is much narrower using the new scoring system, and organisations who have really excelled now find themselves with similar scores to less successful providers. We appreciate the Net Promoter scoring is sometimes difficult to articulate, particularly to patients, although globally this has been effectively communicated across many major organisations for several years now.”

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Capturing the patient experience

MacPherson continued: “FFT is more than just a number of course, and the valuable quality of the comments collected from patients continues to inspire and drive change. FFT has captured the imagination to consider the whole patient experience. Whilst we have yet to see the level of data captured in primary care (there is no minimum requirement of response numbers as there is with the acute sector), the dental community has been particularly enthusiastic on a series of introductory webinars we have been running, engaging with nearly 1,000 dentists and practice managers over the last two months, with the support of regional teams.

“Echoing the organisational development drive of FFT, we have taken this forward with our ‘Towards Service Excellence’ programme, a suite of workshops and webinars drawing from best practice in behavioural design across a range of service industries, designed to fit in to an often challenged NHS. We feel the ‘at desk’ engagement is operationally more accessible for many. We have also been dropping in to selected acute organisations to conduct one hour sessions, which ensures the minimum disruption to shifts. We will have engaged with nearly 5,000 people since last summer and will continue this year.

“In addition, to support providers, our simple ‘Friends & Family Test in a Box’ starter pack for manual data collection is being used by over 3,000 organisations and can be ordered through our website. Whilst we aren’t aspiring to be the Amazon of organisational change, the approach is deliberately in keeping with FFT’s simple accessibility for all.

“Digital solutions continue to play a part, with a continuing developing market for patient insight, particularly from SMEs, plus our current hosting organisation, Arden-GEM CSU, offers text-based solutions. We’ve yet to see the ‘killer app’ to engage the public, but ideas are emerging and it will only be a matter of time. We also need to take ‘near-real-time’ to ‘real-time’ and report FFT daily – which providers have initiated informally in some areas.

“Despite the changes to the Test, we believe in this approach to engagement with both patients and healthcare professionals. We suspect there will be a maturing of the sector, and an understanding of the huge impact customer insight can play in a service industry, which the NHS ultimately is. Despite the huge challenges frontline employees are facing, it is interesting that in many places they are running with the concept, endorsing the vision of this being a bottom-up ‘call to arms’ and near-real-time empowerment.”

Other projects – and Hinchingbrooke

So what does the year ahead look like for the Strategic Projects Team (SPT) aside from the Friends and Family Test?

MacPherson told us: “We have a huge integration agenda, which we are very excited about. We successfully delivered one of the NHS’s largest projects for Cambridgeshire and Peterborough CCG at the end of last year. We are working in Staffordshire on their Cancer and End of Life programme, with Weston NHS Trust on its search for a new partner, and with a new consortium of some great providers in Suffolk on a large bid for community services.

“We are managing some large national procurements and we think that the potential Vanguard projects offer inspiration, as does the Five Year Forward plan for the NHS; its drive for very necessary change has been SPT’s heartbeat, alongside some £6bn of contracts, since 2009.”

The SPT was originally created in 2009 as part of the then-East of England Strategic Health Authority to deliver the franchising of Hinchingbrooke – what are MacPherson’s thoughts on the decision by Circle to quit its contract?

He said: “We exited the Hinchingbrooke project on delivering Circle’s successful start-up in 2012, after a challenging three years in which the model underwent huge amounts of scrutiny before contract signature and mobilisation.

“It was disappointing that the current occupant has not been able to continue after demonstrating so much innovation. We nevertheless remain extremely proud of our groundbreaking work on behalf of the NHS: the franchise model and the permutations we were subsequently commissioned to develop.

“I personally see it as one of a wide range of tools that with courage, commercial skill, and leadership will help challenged healthcare providers continue to deliver a world class service.”

The views expressed in this article are Andrew MacPherson’s own.

Tell us what you think – have your say below or email [email protected]

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