Public engagement with service information is key test of choice
The net promoter score dominates the measurement of customer satisfaction. Indeed many HSJ readers will have contributed to the title’s annual NPS survey.
Respondents are asked if they would recommend a service or product to others. The number who say they would not is subtracted from those who would and an overall score is produced. Across the world millions of corporate reputations and careers hang on NPS results.
The score arrived in the NHS via NHS Midlands and East, the laboratory for many of the radical ideas now being spread across the service. It was disguised under the title of the “friends and family test”. Results are broken down by ward and specialty and performance will affect funding under the commissioning for quality and innovation scheme.
Prime minister David Cameron confirmed his interest in the idea last week in response to a recommendation by the government’s Nursing and Care Quality Forum. Soon it appears every NHS hospital will have its own patient NPS.
The implementation of the system in NHS Midlands and the East has not been uncontroversial. Some leaders in the region have found it distracting and time consuming for staff. They dislike the weight being given to it – when compared to other measures which they believe are more robust and useful.
But it seems unlikely the tide is going to turn. The NHS Commissioning Board has sent a clear message in appointing Dr Foster founder Tim Kelsey as its director for patients and information. Mr Kelsey is a fierce champion of using data to inform patient decisions with a track record of challenging accepted wisdom. He is likely to work hard at ensuring clinical commissioning groups embrace measures of “customer satisfaction”.
There will always be arguments as to the relative weight that should be given to measures that do not directly record clinical outcomes. But few would argue NHS patients would not be happier if more attention was paid to improving the experience of care.
Bupa claimed earlier this year that its customers reported lower satisfaction when treated in NHS private patient units compared with independent providers. Those who dismiss the issue as irrelevant need only read our cover feature and contemplate how much time and energy is consumed by managing problems created by car parking.
You do not have to be a conspiracy theorist to link the push to measure NHS “customer” satisfaction with the moves to accelerate choice for patients. Mental health and diagnostics are the latest frontiers to be explored The Department of Health is also accelerating efforts to establish a “level playing field” for all providers ahead of the new competition regime being established.
The goal is that, before the next election, the population will have become comfortable with and enthusiastic about the idea that services spending NHS funds must demonstrate to the public their ability to provide a good quality healthcare “experience”, an experience which includes both clinical and non-clinical factors. This, it is hoped, will encourage commissioners to offer their populations a range of providers that are able to prove their worth.
Patient preference is the lifeblood of the new system. If patients ignore or reject the information on services as irrelevant or unhelpful it will have little legitimacy. Most NHS leaders know conversations among patients and their relatives have a profound impact on a provider’s reputation. On that basis the friends and family test could prove the measure which engages the public’s attention in a way so many previous, more technical, methods of expressing service quality have failed to do.