IMPLEMENTATION OF THE “FRIENDS AND FAMILY TEST” AT A
MULTISPECIALTY CENTRE IN BANGALORE, INDIA – A STUDY
1
*Dr. Saud Ahmed, 2Dr. Syed Sayeed Ahmed, 3Dr. N. Junior Sundresh and 4Dr.
Mohammed Yunus Kafil
1
Associate Medical Director Primecare (India) Pvt Ltd.
2
Chairman and Managing Director Primecare (India) Pvt Ltd.
3
Associate Professor of Surgery Rajah Muthaiah Medical College Annamalai University.
4
Director - 'Embrace' (Maternity & Paediatric) Primecare (India) Pvt Ltd.
ABSTRACT
As the healthcare industry in India continues to grow at a tremendous
pace owing to its strengthening coverage, services and increasing
expenditure by public as well as private players, measuring the quality
of health care becomes even more important because it tells us how the
health system is performing and leads to improved care. Basically,
there are two approaches for evaluating patient satisfaction-qualitative
and quantitative. The quantitative approach provides accurate methods
to measure patient satisfaction. Standardized questionnaires (either
self-reported or interviewer-administrated or by telephone) have been
the most common assessment tool for conducting patient satisfaction studies. This study
focussed on the 'Friends & Family Test', a popular feedback system used in NHS, UK.
KEYWORDS: Friends and Family Test, Net Promoter Score.
AIM OF THE STUDY
The aim of the study was to implement a robust patient feedback system using the 'Friends
and Family Test' at a Multispecialty Centre in Bangalore, India and to measure patient
compliance with the feedback system.
MATERIALS AND METHODS
The study was conducted from October 2016 to December 2016. The patients in Primecare
Volume 6, Issue 3, 986-993. Research Article ISSN 2277– 7105
*Corresponding Author
Dr. Saud Ahmed
Associate Medical Director
Primecare (India) Pvt Ltd. Article Received on 08 Jan. 2017,
Revised on 28 Jan. 2017, Accepted on 18 Feb. 2017
to give their feedback just before they left the clinic premises. They were given an electronic
device (Tablet) which questioned “How likely are you to recommend our service to friends and family if they needed similar care or treatment ?”. The patient or the relative could
choose from responses ranging from 'Extremely unlikely' to 'Extremely likely' (Scale of 1 to
10). An optional comment could also be made by explaining his choice. Data analysis was
performed by a customised software which captured the data systematically and provided
statistical information at the end of the study.
RESULTS
Total number of patients attending the clinic (Table 1)
Month Total Patients
October 2016 815
November 2016 213
December 2016 644
Total 1672
Total number of Responses obtained (Table 2)
Month Total Responses
October 2016 123
November 2016 166
December 2016 173
Graph 1 showing number of responses - October 2016
Graph 2 showing number of responses - November 2016
Percentage of patients responding to the feedback system
Table 3
Month Total patients Total Responses
Percentage of patients giving
feedback
October 2016 815 123 15.09%
November 2016 213 166 77.93%
December 2016 644 173 26.86%
Type of responses October
Graph 4
Type of responses November
Graph 5
Net Promoter Score (NPS)
Table 4
Month NPS score
October 2016 50.4%
November 2016 48.8 %
December 2016 53.2 %
3 month average 50.8 %
DISCUSSION
In the period of study between October 2016 and December 2016, the front desk staff at
Primecare Multispecialty clinic were trained to counsel the patients for providing feedback.
About 27% of the patients attending the clinic provided feedback over 3 months. The average
FFT response was found to be 8.6 and the average Net Promoter score was 50.8.
Patient satisfaction can be defined as fulfilment or meeting of expectations of a person from a
service or product. When patients visit a health care provider, they have a preset notion of the
various services of the hospital as per the reputation and cost involved.
The Friends and Family Test” is a patient feedback system used in NHS, UK and since its
launch in April 2013 has produced more than 25 million pieces of feedback making it the
biggest source of patient opinion in the world.
Standardized questionnaires (either self-reported or interviewer-administrated or by
telephone) have been the most common assessment tool for conducting patient satisfaction
studies.[1,2]
While some researchers focus on patient satisfaction with the quality and type of health-care
services received[3,4,5,6] others focus on people‟s satisfaction with the health system more
generally.[7,8,9,10]
One critical area of patient interaction is the Out-Patient department (OPD) as it provides
greater insight into the functioning of the entire hospital. The OPD in any hospital is
considered to be shop window of the hospital.[11,12]
Patients carry certain expectations before their visit and the resultant satisfaction or
Private hospital care cost also has gone very high. With the advent of Consumer Protection
Act (1986), the patient's expectation has also gone very high. Now hospitals have to be very
careful about patient dissatisfaction to avoid any unnecessary litigation and poor reputation in
the community.
Hospitals have evolved from being an isolated sanatorium to five star facilities and boutique
hospitals.[14]
Knowledge of expectation and the factors affecting them, combined with knowledge of actual
and perceived healthcare quality, provides the necessary information for designing and
implementing programs to satisfy patient.[14]
Healthcare facility is very difficult to measure; hence, it is a challenge to a healthcare
provider to influence a patient's perception of quality of care.
Attributes of Quality of Healthcare
Donabedin Avedis has described the key properties of healthcare that constitute quality as:
Effectiveness, efficiency, optimality, acceptability, legitimacy and equity.[14]
Hendrickson examined effects of implementing nursing information computer system in 17
Hospitals in New Jersey, USA. They observed that staff impression of the effects of system
was positive; documentation was better (more readable).
Cock et al[15] conducted a continuous quality improvement study in their medicine
department of McMaster University, Faculty of Health Sciences, Ontario by monitoring
patterns in medical teaching ward. They found that in 68% of cases, oxygen therapy was
initiated by house staff, nurse initiated therapy in 18% of cases, but discontinued it more
often than any other health worker. About 30% of patients on oxygen did not meet the criteria
set by American College of Chest Physicians. This showed that practice guidelines based on
best available evidence are needed to increase the efficiency of oxygen use.
Khosla et al[14] found in their study, emphasis by the patients of two Delhi hospitals on
varying needs according to their income groups:
- Low Income Group- improved physical facilities, improved diet and relaxation of visiting
- Middle and High Income group- personal and prompt attention of doctors, better behaviour
by Class IV staff, improved physical facilities, relaxation of visiting hours.
As a part of their study, Chopra et al[16] carried out participant‟s observation in patient role in
a hospital and confirmed through a flow chart that the aforesaid two factors led to better
output i.e., recovery, which in turn led to patient satisfaction. In their report, hospital food,
communication, discharge policy, use of influence, nursing orderly and sweepers were
identified as dissatisfying factors. However, it was concluded that best possible hospital
services might take care of patient dissatisfaction but to attain positive satisfaction, patients
must have a good medical care.
Based on the global Net Promoter Score (NPS) standards, any score above 0 would be
considered “good” (50 and above being excellent while 70 and above is considered “world class”).[17]
CONCLUSION
In this study we were able to an implement a robust patient feedback system in Primecare
Multispecialty Clinic which was simple and which is currently used by the NHS, UK.
The patient compliance was about 27 percent and could be improved by placing FFT
informative material on display at the clinic.
The net promoter score provided a valuable source of information for Directors, investors and
other stake holders in the company.
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