Original Research Influence of patients’ age and sex and the mode of administration on results from the NHS Friends and Family Test of patient experience Steve Sizmur, Chris Graham and Joan Walsh Abstract Objective: To investigate the impact of demographic factors (patients’ age and sex) and of the mode of administration of a national patient experience questionnaire in England: the NHS Friends and Family Test. Methods: Secondary analysis of April–August 2013 data collected using a mixed mode approach from 38,998 inpatients and 29,610 emergency department attendees at 429 wards or units in 32 hospitals. Multilevel models were applied with responses from wards nested within hospitals and trusts. Age, sex and mode of administration were entered as main effects. Results: There were consistent differences in response for patients and emergency department attendees related to their age and sex. Women gave less positive ratings than men, whilst the likelihood of positive responses increased with age except among the oldest age group (75 years and above). As regards mode of administration, online responses were significantly less positive than postcard responses: the mean differences in score were 22.0 points for inpatients (95% confidence interval 27.3 to 16.7) and 18.0 points for emergency department attendees (29.0 to 7.0). Telephone responses were significantly more positive than postcard responses, with a mean difference of 9.2 (1.6–16.8) in the emergency department setting. Conclusions: Data from the Friends and Family Test are vulnerable to bias from demographic factors and from the mode of administration. Comparisons between organisations should be avoided. Scores may be useful at a local level where the test is implemented consistently and patients’ demographic characteristics remain stable. Improving the utility of the Friends and Family Test nationally requires a standardised method for administration and adjustment of results for demographic characteristics. Keywords Friends and Family Test, patient experience, patient satisfaction Introduction In May 2012, the British Prime Minister, David Cameron, announced the introduction of the ‘Friends and Family Test’ (FFT) ‘to improve patient care and identify the best performing hospitals in England’. 1 It was intended to identify issues and areas for improve- ment and so ‘drive cultural change and continuous improvements in quality’. 2 It has rapidly become a ubi- quitous and high-profile policy tool, promoted both as a performance indicator 3 and, by giving ‘everyone a really clear idea of where to get the best care’, as a lever for patient choice. 1 From April 2013, National Health Service (NHS) standard contracts required implementation of the FFT across all acute inpatient and hospital emergency (A&E) services. NHS maternity services were required to introduce the FFT from October 2013 4 and it is to be extended to all other services by April 2015. 5 In addition, a version for NHS staff will also be introduced from April 2014. 6 The stated intention is to introduce ‘a standardized method- ology’. 2 There is, however, no requirement for organ- izations to adopt a consistent approach to administering the FFT. Survey Statistician, Picker Institute Europe, Oxford, UK Corresponding author: Steve Sizmur, Picker Institute Europe, Buxton Court, 3 West Way, Oxford OX2 0JB, UK. Email: steve.sizmur@pickereurope.ac.uk Journal of Health Services Research & Policy 2015, Vol. 20(1) 5–10 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1355819614536887 jhsrp.rsmjournals.com by guest on December 16, 2014 hsr.sagepub.com Downloaded from