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More than a number: making the most of the Friends and Family test with free text analytics

Of late, frequent and loud voices have questioned the efficacy of the FFT, but nearly all have continued to focus on the score that will result from the test. However, as the more discerning have noted from the start, we need to look beyond this to make the test work for us. To do so, we must collect free text alongside the tick box rating question and use free text analytics to make sense of this data, argues Toby Knightley-Day.

The question of free text revisited

In all Friends and Family Test (FFT) surveys mandated so far, free text is an optional element to the test. To conform to the guidelines, trusts must ask 15% of their inpatients and A&E users whether they would recommend the services they received to their friends and family if they had a similar need. Asking them why they gave the score is not required. This process will provide a quality measure for a provider’s services and should help to highlight any developing care failures; it will not inform trust or ward managers of how they might reverse or correct their shortcomings.

Implementing free text alongside the tick box answer is then not just preferential, it is essential if trusts want to listen to patients and improve services. The flexibility of free text allows patients to make unrestricted comment on their care experience; however, these responses should not be confused with or treated as patient stories, but as another dataset to feed analysis. Although unstructured, this feedback is targeted, pithy and revealing, making it ideal for informing frontline staff. Furthermore, rather than restricting responses to a set of questions, by using this process we accept we do not and cannot know everything that can affect the patient experience.

If collected as suggested, FFT data will be divided into quantitative and qualitative forms. Understandably, the former is considerably easier to interpret than the latter; however, it is the latter that holds the answers to improving service delivery and, thus, a ward’s or trust’s score. Just knowing what percentage of your patients would or would not recommend your services to their friends and family is not enough.

Knowing why they feel that way is far more likely to deliver the necessary insight to drive service improvements.

Finding clarity: getting data interpretation right

Quantitative data naturally lends itself to rapid interpretation, with outputs of charts and tables that are easy to compile as well as disseminate and absorb. Conversely, collections of short text answers present an intimidating information barrier between you and your patients. This barrier, however, does not have to be insurmountable.

At present, qualitative data all too often disappears into complaints departments or the Patient Advice and Liaison Service (PALS), but the anecdotal outputs from these services are invariably trumped by the demand for quantitative information resulting from the ‘big data’ agenda. The real power of FFT free text is the direct connection it draws between patient experience and point of service delivery. Consistent and accurate coding can transform these would-be anecdotes into extremely powerful and versatile outputs that, when plotted, can highlight where a collection point (a ward, for example) is excelling or coming up short.

Driving improvements with analytics

It is time to forget the macro picture and think about the frontline. Not many tools in the NHS managerial arsenal put staff in direct contact with individual patient experiences. As a result, there is huge potential in the FFT to empower staff to make real improvements in the way they serve their communities – be it through large changes, such as altering shift patterns or reviewing subcontractor arrangements for hoteling services, or a small change, such as managing visiting times differently. It will also offer insight into staff behaviour and team culture, something near impossible to observe from the inside looking out.

As with any initiative of this kind, implementation is the key to success. Put in place with the right intentions and staff endorsement, the FFT can and will change the way you provide services to the population you serve.

Pay lip service to the idea and meet the minimum requirements, and it will be of considerably less value to you and your patients.