Intended for healthcare professionals


Friends and family test should no longer be mandatory

BMJ 2018; 360 doi: (Published 29 January 2018) Cite this as: BMJ 2018;360:k367
  1. Glenn Robert, professor of healthcare quality and innovation1,
  2. Jocelyn Cornwell, chief executive2,
  3. Nick Black, professor of health services research3
  1. 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
  2. 2Point of Care Foundation, London, UK
  3. 3London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to: G Robert glenn.robert{at}

Valued by policy makers but generates little insight for practitioners

Don Berwick, an international leader in the safety and quality of healthcare, has called for “a significant reduction in the volume and total cost of measurements currently being used and enforced in health care.”1 He is not alone in arguing that a belief in accountability and market theory “has brought with it excessive measurement, much of which is useless but nonetheless mandated.”2

The inpatient “friends and family test” was introduced in all English acute hospitals in April 2013. The aim was to provide a simple metric that, when combined with follow-up questions, could be used to drive cultural change and improve the quality of care.3 The main question is “How likely are you to recommend our service to friends and family if they needed similar care or treatment?” and respondents can rank their answer from “extremely likely” to “extremely unlikely.” The test was formally reviewed after the first six months of data collection and subsequently extended to maternity, outpatient, ambulance, mental …

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