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Friends & family test: understanding our patients' & families' experience

Friends & family test: understanding our patients' & families' experience

What is the 'Friends & Family Test'?

Patient experience is one of the three key components of quality: patient safety, clinical effectiveness and patient experience.  Healthcare providers who aim to provide high quality patient care have recognised the importance of understanding and improving the experience of services as reported by patients and their families.  This is because numerous studies show highly correlated links between patient’s views of their experience of care and their reported treatment outcomes.

Value: Everyone MattersThere is only really one way to actually use patient experience to drive quality and, ultimately, better patient outcomes, and that is to ask the patient and their families about their experience of care and use this to identify possible areas for improvement.

Friends & Family Test: Question 1The 'Friends & Family Test' is a way of gathering feedback about patients’ and their families experience of care.  The test was developed in the UK and is now an integral part of Putting Patients First, National Health System (NHS) England’s Business Plan for 2013-2016.  In May 2013, the UK’s Prime Minister announced that the 'Friends & Family Test' would be introduced across the NHS.

The test aims to provide a single, simple headline measure of a patient’s experience with answers on a scale of extremely likely to extremely unlikely.  For example - "How likely are you to recommend our <ward/department/service> to friends and family if they need similar care or treatment?"  

When combined with follow-up questions, the 'Friends & Family Test' can drive a culture of patient centred care, recognising good practice and opportunities for improvement in the experience of care received by patients and their families.

What are we trying to achieve?

We want to ensure that our patients and their families get the best care possible. To do this, we need them to provide us feedback on their experience.

The 'Friends & Family Test' provides patients and their families with the opportunity to give feedback on the quality of care and treatment they receive, giving us a better understanding of their needs and enabling us to make improvements to the care and treatment we provide.

Experience in the UK has shown that the 'Friends & Family Test':

  • enables the views of patients and their families to be heard and provides a platform to shape and deliver better services.  Patients are able to use the information to make decisions about their care and to challenge their health care providers to improve services while championing those who excel
  • informs and empowers employees from ‘boards to wards’ to tackle areas of weak performance and celebrate and build on what’s working well, using the results from this test and other sources of information
  • enables various levels of an organisation (e.g. wards, departments, leadership teams), to track trends in test results. This provides validation of where targeted improvements are most effective and results can be used with other quality indicators and measures to provide more in-depth understanding of issues and areas of improvement

What have we done?

We worked with a team from the National Institute of Health Innovation to create a survey of the 'Friends & Family Test' tailored to Waitemata DHB for patients and their family using handheld electronic tablets.

The Waitemata DHB 'Friends & Family Test' asks the following questions:

  1. How likely are you to recommend our ward / service to friends and family if they need similar care or treatment?
    • Please tell us the main reason you gave that score [this is the only free-text section]
  2. Did we see you promptly?
  3. Did we listen and explain?
  4. Did we show care and respect?
  5. Did we meet your expectations?

In addition we ask the patient or family member to provide some general information including their age bracket, gender, and ethnicity to help us analyse the results.

Friends & Family Test: Questions 2&3 Friends & Family Test: Questions 4&5
Questions from Waitemata DHB 'Friends & Family Test'

We purchased 30 handheld tablets and asked Charge Nurse Managers across the organisation to act as 'Friends & Family Test' champions.  This would help us test the application over a wide variety of sites including in the hospitals’ wards, in outpatient clinics and in the community with our community service teams. 

Patients and families are asked if they would like to complete the survey and results are immediately uploaded at the end of the survey.  This means that we are able to receive ‘real time’ feedback from patients and their families, while the patient is on the ward or in the department, and the results are immediately available for staff to view via an internet site.

The survey is completely anonymous so the results cannot be traced to a patient or family member.


We began to use the tablets to survey patients using the 'Friends & Family Test’ in June 2013.

Since July, approximately 520 responses have been obtained in 29 departments.  Some technological challenges with using the tablets were initially identified and a “how to guide” has been developed. The number of wards, services and departments undertaking the survey has been increased and data in September 2013 shows 285 responses and surveys being undertaken in 22 areas by patients / family members.

Further development work is underway to improve data analysis and use by staff.  For example, we want staff to further investigate their ward / service / department results to get more detailed information about what their patients and families think about the care they are providing; additions to fields to improve data capture have been made (including the ability to search results according to a time of day), and a Wordle[1] (see below) has been created to reflect the free text comments made in response to the question about whether the patient or family would recommend the ward/department/service.

Results of the survey can be accessed at: http://gateway.ctru.auckland.ac.nz/WDHBSurvey/Results are sent to charge nurse managers each week and are discussed at weekly meetings.

Friends & Family Survey Results
Example of live survey results from 'Friends & Family Test'

Initial results demonstrate that:

  • 92.4% of patients and family are either very likely or likely to recommend the ward / department / service to family or friends if they needed similar treatment
  • family members are generally more positive than patients
  • males are generally more positive than females
  • ethnicity data is not yet meaningful until more responses are captured

'Very likely to recommend' wordle
Wordle[1] of comments from survey respondents who reported as "very likely to recommend the ward / department / service"

  1. A Wordle is a tool for generating “word clouds” from text provided. The clouds give greater prominence to words that appear more frequently within the text.

Comparison with the NHS, UK

The National Health System (NHS) first published their 'Friends & Family Test' from July 2013.  The NHS scores are calculated using the underlying net promoter score methodology by analysing responses and categorising them into promoters (would recommend), detractors (would not recommend) and neutral (passive) responses.  The proportion (not %) of responses that are promoters and the proportion that are detractors are calculated and the proportion of detractors is then subtracted from the proportion of promoters to provide an overall ‘net promoter’ score.

Those that say they are ‘extremely likely’ are counted as promoters.  ‘Likely’ is neutral, ‘neither unlikely nor likely’, ‘unlikely’ and ‘extremely unlikely’ are all counted as detractors.  The NHS methodology requires a 15% response rate and asks patients for their feedback after discharge from hospital or a service.  Waitemata DHB has taken a different approach in that we ask patients and family to feedback during their hospital stay.

Data is therefore not directly comparable and it is too early to draw conclusions from the Waitemata DHB data at this stage as more responses are required to enable meaningful analysis.

English NHS National scores
[source http://www.england.nhs.uk/2013/07/30/nhsfft/ ]

Waitemata DHB






Sep 2013