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Friends and Family Test – Will NPS® work for the NHS?

At the beginning of 2013, UK Prime Minister David Cameron created quite a stir with the proposed introduction of a Friends and Family Test for NHS patients. The full BBC article can be read here.

What is the Friends and Family Test?

The introduction of a Net Promoter Score (SM) style test gives a very strong indication as to the levels of satisfaction a patient has had from the service they received by asking them how likely they would be to recommend the service to their friends and family.

However questions have be raised by some medical professionals as to how relevant this type of test is. Some medical procedures and services are so complex in nature, it is understandable that professionals might question how capable patients are of assessing the level of service they have received. After all, medical professionals have spent many years learning how to deliver this type of service, so how easy is it for the recipients of the service, with relatively little knowledge and experience, to make these types of qualitative judgements?

The crux of the issue comes down to the nature of a service’s attributes. A study undertaken by Nelson, Darby & Karni in the 1970s proposed that there are three key attributes against which a service or product can be judged; namely their Search, Experience and Credence qualities. Search relates to how easy is to discover information relating to the service; Experience is all about how easy it is to judge the service on the basis of your experiences; and Credence is all about the degree of trust you need to have in the person delivering the service as a result of limited knowledge and understanding; i.e. when the service is being delivered by a “professional” who has a better understanding than the service recipient. So, a ride on a rollercoaster is extremely high in experience qualities – everyone has the ability to judge the degree of fun and excitement they have had on the ride; whereas a car service is very high in credence qualities – most motorists need to rely on the trustworthiness of the mechanic as to whether a comprehensive job has been done or not.

NHS services are, of course, very high in credence qualities. If any of us had recently had an operation and were subsequently asked how successful the operation had been, we would have limited information available to us. We can make judgements relating to the fact that we are still alive, or to the level of pain we might be still be suffering from; however we would be reliant on the advice of the surgeon as to the degree or extent of success the operation had achieved. This being the case; when you ask a hospital patient about their experiences in a hospital; they tend to focus on the things that they find it easier to judge – the factors with the highest experience qualities; such as the quality of the hospital food; or the responsiveness of the hospital staff. For patients; factors such as the successfulness of the operation are almost secondary considerations – you could even call them ‘hygiene factors’, as almost everyone expects a routine medical procedure to be successful.

For the medical professionals however; the factors being utilised by the patients to judge the service quality are secondary. These people are measured and judged against completely different criteria; such as the number of successful procedures and patient turnover. Considering the degree of pressure these professionals are under; it must sometimes be very difficult for them to understand the mindset of the patient. However the judgements and concerns of the patients are still very real and very relevant. After all, only patients can know how they truly feel, both emotionally & physically.

The challenge for this new initiative will be striking a balance between the perceived and actual levels of care received. Understanding the difference between perception and reality is a key principle of Customer Experience management; however in this instance it is further complicated by the fact that the service provided is so high on the credence scale. The British taxpayer needs to feel as if they are gaining value for money from the initiative and NHS Trusts face an interesting challenge in terms of striking the right balance when these tests are being set up. It will be very interesting to see how this develops.

Net Promoter, NPS, and the NPS-related emoticons are registered service marks, and Net Promoter Score and Net Promoter System are service marks, of Bain & Company, Inc., Satmetrix Systems, Inc. and Fred Reichheld

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