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Narnia brought magical changes to a primary care leaflet display

The NHS has announced from April it will improve the way it uses the Friends and Family Test patient feedback tool.  A member of a Patient Participation Group (PPG) at Romney House Surgery in Gloucestershire, tells us how even simple comments from patients can drive real improvements for those who use healthcare services: 

When I was elected chair of my surgery’s PPG, I looked at what other groups were doing to help their busy surgeries.

One example was a video on Somerset Clinical Commissioning Group’s website about how a PPG was helping their surgery to run the NHS Friends and Family Test patient feedback tool and I thought we could do something similar at my surgery.

Initially, I asked the practice manager if I could see the recent FFT forms. When he placed a year’s worth in front of me, I knew I would have my work cut out, but had no idea of the journey it would take me on.

As I started looking through the feedback, it quickly became clear there was a goldmine of information in the patient comments. For instance, people would tick the box indicating they would ‘definitely recommend’ the practice to their friends and family, and would write: ‘The consultation with the GP was brilliant,’ but then add ‘…but I had to wait an hour in the waiting room for him.’

I figured the positive recommendation might be down to gratitude bias: perhaps people were so grateful to get an appointment that they might try to downplay anything negative.

Hiding in our mainly positive quantitative data were nuggets of information reflecting what our patients really thought, which could be used to make improvements.

One piece of feedback was so plain and simple, there was no question as to what we had to do. It read: “The GP told me to get the leaflet on mental health services from the waiting room, but I couldn’t find one.”

It was such a simple problem to solve, or so I thought.

I found out that the leaflets were kept in an old cupboard that staff called Narnia because no one had seen the back of it for years. A member of staff had previously kept it tidy, but she had retired several years earlier.  I found the mental health leaflets and put some out on display straight away.

I raised the leaflets issue at the next PPG committee meeting. One of our members pointed out that people didn’t like to stand in front of everyone in the waiting room looking for leaflets; there was no privacy, everyone could watch which leaflet they were taking. We asked the practice manager if the leaflet stands could be moved to the corridor by the dispensary. This way patients could quietly look at the leaflets with more privacy. Additionally, it also meant those queueing up at the dispensary had something to look at.

We began a reorganization of the leaflet display by removing anything out of date.  Because we felt that what was on the leaflet stands would be seen as approved by the surgery, we removed anything that wasn’t related to the NHS or health and wellbeing.

We rearranged them, putting information about the dispensary and the pharmacies right beside the dispensary window, and other more sensitive leaflets further away where patients could have more privacy. Once it was all sorted, we agreed that the PPG would keep it tidy and up to date and I volunteered to sort out the Narnia cupboard.

There were some fascinating finds. Some of the little booklets must have been 30 or more years old, plain brown NHS austerity from a previous generation. There was even a long-lost clinical waste bin key, no doubt accidentally left there while someone was getting a new supply of leaflets.

I then used a technique called card sorting to find out how people would expect the topics to be organised. It is a method that is often used to arrange pages of a website but works equally well for sorting out which leaflets to put together on each shelf. I labelled each shelf so that it was easier for PPG members to top up the leaflet stands and for staff to find things.

So, what started out as a single one-off comment in the free-text box of a patient’s FFT form, turned into a PPG project that made several improvements.  Although the back of the cupboard didn’t lead to Narnia, it did lead to a better experience for patients and staff alike.

Jennifer Skillen

Until recently Jennifer Skillen was the chair of her GP surgery’s patient participation group in Gloucester, getting involved not just with the surgery, but in local commissioning.

She is passionate about the NHS and reflecting the patient voice to develop effective patient-centred planning.

Jennifer enjoys applying the knowledge she gains from studying part-time for a PhD to a variety of situations, from dealing with her disabled son’s ’therapy’ chickens to helping with the patient views in quality improvement.

She has recently had a paper published by Sage Journals about the kind of simple analysis techniques that can be used to make sense of FFT feedback. It is entitled ‘The Friends and Family Test: From card sorts to control charts’.

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