The NHS Friends and Family Test (FFT) was created and launched in 2013 to help service providers understand whether patients were happy with the service provided, or where improvements were needed, writes RCR/CoR quality improvement partner Sally Walker. 

By 2019, the FFT had resulted in more than 75 million pieces of feedback – and the total rises by around 1.3 million more each month. The FFT gives all patients the opportunity to rank their experience of the service from very good to very poor, with free text available to provide comments to the service. Listening to the views and experiences of patients, their families and carers, helps services to identify what is working well, what can be improved and how.

What is experience?

Every day we all have experiences, both good and bad, but have you ever noticed that the better or worse the experience is, the more people you tell? We all experience things slightly differently and each experience is made up of several experiences or moments and these are often measured up against our original expectations.

“Patient experience” can be described as what the process of receiving care feels like, not only for the patient but also the family and carers. Services need to ensure that everyone has a say about their experience around respect, dignity, and clinical care but there are also other factors that form part of someone’s whole experience. This might include elements such as clarity and accuracy of communication, accessibility and inclusivity, politeness of staff, cleanliness, on-site facilities, parking, signposting, appointment booking, waiting, and provision of information.

The Experiences Based Design (EBD) approach focuses on capturing and understanding the experiences of patients, carers, and families, not only to hear their views of the process but to help design better healthcare.

The EBD approach centres on four stages:

• Capture the experience
• Understand the experience
• Improve the experience
• Measure the improvement

By asking patients, carers, and families to share their own experiences, we can then begin to understand the emotional journey that people experience when they visit our service. By understanding and utilising this information we have a powerful new tool for improving care in ways that matter most to the people who use it.

How to capture and understand the experience?

There is no right or wrong approach, and each service will be doing it slightly differently. Services could consider mapping patient “touch points”, such as arrival at/leaving the site, waiting area/times, information received and asking patients to associate their emotions, anxious, safe, lonely, sad or happy at each point. Understanding patient experience is a fundamental part of service improvement and offers an important “health check” of services, providing an indicator for managers of what’s working well, and helps to monitor and improve patient experience. This can be achieved through a range of activities that capture direct feedback from patients, service users and wider communities.

Using data from patient satisfaction questionnaires, complaints, the Patient Advice and Liaison Service (PALS) or social media and online feedback, can really help services to understand the experiences of patients.

Wherever your source of information on patient experience comes from you are looking to understand the people’s experiences of the process: What did they feel when they used the service? When did they feel it?

The Quality Standards for Imaging underpins the vision of the RCR and CoR that all providers of imaging services are invested in a continuous quality improvement journey. It allows services to evaluate their performance and develop them where needed to continually improve patient experience and outcomes. QSI can help services to improve the experience for all and to then measure that improvement.

Within the QSI there are requirements throughout which relate to services having a clear process for obtaining feedback from their patients. In XR 109, services need to be able to demonstrate that they have processes in place for receiving regular feedback about the care they have received, that patients are involved in decisions about the service design and organisations and how any changes are communicated to patients.

Services should be working in harmony with the patients that they care for and involving them, their families, and carers where possible in decisions about the development of the service. As a service, do you involve your patients in service design or how to provide information to your patients on changes as a result of feedback received?

Understanding and capturing feedback about all aspects of their experience is embedded within the standard, from the information that they receive about their procedure (XR102), ensuring that their privacy and dignity was maintained (XR 105) to ensuring that the environment (XR 107) met their needs. It’s not only important to ask patients about their experience, it is vital to include all staff, and this can also be done through staff surveys or team meetings. In XR208 Supporting Staff and Staff Wellbeing, the QSI highlights some of the range of measure that services should consider ensuring that staff also have a positive experience at work and can see positive change and improvement due to their feedback.

All this feedback can then be used to develop a service improvement plan and in XR604, services need to be able to evidence how they measure patient experience and that the outcomes link directly to the service improvement plan.

If you or your service has really made a change because of feedback received and you would like to share this experience, please get in touch with the QIP at QSI@RCR.ac.uk.