DAYSAFE is co-funded by the European Commission under the Programme of the Community Action

in the field of Public Health 2008-2013

Grant Agreement 2009 1104

DELIVERABLE N° 9

GUIDELINES FOR PATIENT SATISFACTION QUESTIONNAIRE WP7

Period covered: from M29 to M36 Month of delivery: M36 + 2 Submission date: 30 November 2013

2

Work Package Leader:

National Institute for Health and Disability Insurance NIHDI Belgium

Participating Countries:

Belgium AZ Sint-Augustinus vzw - GZA Denmark

Association of Danish Regions - ADR France Haute Autorité de Santé - HAS

France Agence Nationale d’Appui à la Performance - ANAP

Hungary

Europ-Med KFT - EUROPMED

Italy Agenzia Nazionale per i Servizi Sanitari Regionali - AGE.NA.S

Italy

Azienda Ospedaliera di Padova - AOP

Norway Martina Hansens Hospital – MHH

Portugal Administração Regional de Saude do Norte, IP – ARSN Portugal Centro Hospitalar do Porto, EPE – CHP

Romania County Emergency Hospital, Timisoara - SCJUT

Spain Catalan Agency for Health Information, Assessment and Quality - CAHIAQ

3

Collaborating Partner: International Association for Ambulatory Surgery – IAAS *

* The IAAS is an international scientific society whose membership brings together the National Societies representing all professional figures involved in the day surgery process from all over the world.

Australian Day Surgery Assocation, ADSC

Ambulatory Surgery Center Assocation, ASC

Belgian Association of Ambulatory Surgery, BAAS

British Association of Day Surgery, BADS

Danish Association of Day Surgery, DSDK

Dutch Association of Day Care & Short Stay, NVDK

Finnish Ambulatory Anaesthesiologists, SUOPA

French Association of Ambulatory Surgery, AFCA

German Association for Ambulatory Surgery, BAO

Hong Kong Association of Ambulatory Surgery, HKADS

Hungarian Association of Ambulatory Surgery, HAAS

Indian Association of Day Surgery, IADS

Norwegian Day Surgery Association, NORDAF

Portuguese Association of Ambulatory Surgery, APCA

Society of Ambulatory Anaesthesia, SAMBA

Spanish Association of Major Ambulatory Surgery, ASECMA

Swedish Association of Day Surgery, SADS

4

INDEX ________________________________________________________________________________________________ 1 HOW TO MEASURE PATIENT SATISFACTION Pag. 5 2 REFERENCES Pag. 9

__________________ Appendix A Available instruments: Pag. 11 the WARWICK PATIENT EXPERIENCE NETWORK Pag. 12 the PATIENT SATISFACTION QUESTIONNAIRE (PSQ) Pag. 23 Long-Form PSQ-III Pag. 24 Short-Form PSQ-18 Pag. 29

5

1 HOW TO MEASURE PATIENT SATISFACTION _________________________________________________________________________________________

Most industries delivering services or products have been paying attention to customer

satisfaction for decades. Health care is the only large industry that for years has left the

customer out of it, on the belief that patients do not have the knowledge and skills to

understand what is going on inside themselves and between them and the providers. The

medical culture maintains that health care is unique and the only people trained well

enough to really understand what is supposed to happen are the doctors. But this stance

does not make any sense from a moral, ethical, political, and professional viewpoint. In a

democratic society where most conditions are chronic and need strong involvement of

patients, some of whom are highly educated, paying no attention to the opinions of the

patients, and stating that their expectations are extraneous to clinical thinking is akin to

live bogged down in a remote past, secluded from the flow of history.

The rationale behind the decision to adopt a patient survey has multiple motives. Patient

satisfaction surveys allow healthcare managers and providers to identify areas and topics

for services improvement, which should result in better outcomes, both in terms of

patients more pleased by the care they received, and in terms of recovered health status.

These surveys have also a symbolic meaning, signalling the staff and the community that

the leadership invests in quality, and therefore measures, learn about, and improve it.

Another good reason to carry out patient satisfaction surveys is goodwill, i.e. the

importance to gain the support of actual and potential users. Finally, surveys will also

reveal practice's successes, and bring about positive reinforcement which boosts morale

and willingness to do even better. In other words, the process of improving quality, can

also contribute to move away from a paralyzing blame culture.

Topics which should be considered for investigation include: Patient as active participant;

Responsiveness of services; Customization; Continuity of care and relationships; Lived

experience; Communication; Information and Support. A key principle in developing a

questionnaire is “Keep it simple”. This means limiting your questions to the top three

issues regarding:

a) provision of quality health care;

6

b) accessibility to care;

c) interaction between patients and healthcare organization and to considerate and respectful conduct with patients.

The survey questions should cover each of the three areas: quality issues (i.e., how far are

patients satisfied with their medical care?), access issues (i.e., how easy is to make an

appointment or get a referral?), and interpersonal issues (i.e., are the physicians and staff

caring and compassionate?).

A survey questionnaire should be brief, clear and consistent. An in-house survey can be

valid and reliable if some basic rules are followed. They entail staff-related costs, such as

the time spent designing the survey instrument, selecting a sample, preparing the survey

for mailing, tabulating the responses and analyzing the data. The main physical costs of a

survey include paper, printing and postage. If the organization does not have in-house

know-how, experts and healthcare research firms can provide tested survey questionnaires

and handle the entire survey process, including data analysis. In any case, feedback to

providers should be offered with the assistance of an external consultant, whose

judgement can be more acceptable to staff and more balanced.

A patient satisfaction survey should be carried out only if the context is ready to take

coherent action with the information collected, i.e. it has embraced quality improvement

and patient centeredness as core values and goals. Conducting a survey without following

up on the results, might create more damage than doing nothing, i.e. worsen frustration

among healthcare providers and intensify disaffection among users. Staff should be kept

well informed about the process from the very beginning, letting them know approaches to

sense-making and acting on the results. Improvement cannot be achieved through

improvisation, or a magic wonder. Organizational leaders, managers and staff should be

knowledgeable with improvement strategies, such as PDSA cycles and/or lean and six

sigma techniques.

Acting on every suggestion offered by patients is impractical. Issues and problems causing

dissatisfaction should be prioritized together with solutions. The latter should be brought

together in a coherent strategy, averting a piecemeal approach which might only have a

limited impact or, possibly, as systems theory suggests, a paradoxically harmful effect.

7

A frequent concern of patients is waiting time in the ambulatories. A useful step toward a

solution is adopting a time-analysis worksheet, which tracks patients' visits by the minute

for the time a patient arrived at the office, entered the exam room, was greeted by the

doctor and so on. This information allows the physicians and staff to see how they are

spending their time and identify possible sources of delays. Patients tend to consider

waiting time as at least or even more important than competent medical care, which is

counterintuitive for most healthcare providers. Most patients place access issues at the

top of their list of what makes them satisfied. The essential question, i.e. “Overall, how

satisfied are you with your physician?” should also be asked. This is important because

organizations and external stakeholders need a key summary of performance from the

perspective of patients.

Questions should be carefully worded, brief, easy to understand and focused. It is of the

outmost importance to avoid asking biased, vague, or leading questions, or queries that

incorporate two or more questions. The use of scales should be consistent, i.e. most

questions on a patient satisfaction survey should be answered using a single scale, such as

10-point scales, or Likert scales (e.g., five points ranging from “strongly agree” to “strongly

disagree” to “strongly agree” or from “excellent” to “poor”). The latter represents the

most generally used and accepted scale. At least a couple of open-ended questions should

be included, like “What do you like best about our practice?” or “What are we doing

especially well?” and “What can we do to improve?” Qualitative data from verbatim

comments are very rich providing invaluable insight concerning the how and why of

patients’ satisfaction or discontent. When examining the results, combining responses

together into broad categories, for example bringing together scores for “excellent” and

“very good” into one category called “satisfied”, should be avoided because it dilutes

information. Instead a weighted score should be calculated based on each respondent

score. This means, if a Likert scale has been adopted, five points for each person who said

“excellent,” four points for “very good,” three points for “good” and so on.

Socio-demographic data will help understanding which groups of patients raised a certain

topic. Interviewees should be kept anonymous, because they are more likely to answer

survey questions honestly if they believe their identity is protected. Patients should be

able to complete their surveys in private and return them without fear of being identified.

8

In some cases, patients may want to provide their names, in order for a staff member to

contact them about their comments or concerns, and they should be allowed to do so.

Feedback from patients can be seek through various tools: phone surveys, written surveys,

focus groups and personal interviews. Most practices will want to use written surveys,

which tend to be the most cost-effective and reliable approach. With a written survey,

practices have the option of creating a questionnaire from scratch or using a product that

is already been developed by an outside vendor. Most experts recommend the latter

because the product has likely been tested and validated. Doing it in-house is possible, but

it is time-consuming, taxing on the practice's internal staff, and requires solid expertise.

Statistical reliability, i.e. repeatability of results, is a key issue, once the instrument has

been validated. Sample selection should be randomized, for example one patient every

fifth starting from a random selection, and size should be large enough to allow a

reasonable statistical power. Even if more costly, mailing surveys constitute a preferable

option than handing them out in the office. Physically handling the surveys and being able

to influence which patients receive them can introduce systematic error. Staff might be

tempted to skip an irritated patient and substitute him/her with the next one, which would

introduce bias. Using a drop box is not a good idea either because it is too often ignored.

Data analysis and, above all, sense making represent the most difficult steps of the survey

process. Strong expertise in database-management and analytic skills are preconditions for

carrying out a solid investigation. However, these are still not enough without

professionals who have direct experience of services delivery and a capacity to

conceptualize this topic and explain the implications of the results. Otherwise an

organization runs the risk to end up with a stack of surveys that are never analyzed

adequately.

9

2 REFERENCES

_________________________________________________________________________________________

Abramowitz S., Cote A., Berry E. (1987), Analyzing patient satisfaction: a multianalytic approach. Qual rev Bull, Vol. 13:122-30. Arah O. A., Westert G. P., Hurst J., Klazinga N. S. (2006), A conceptual framework for the OECD Health Care Quality Indicators Project. International Journal for Quality in Health Care; Vol. 18: 5-13. Brown A.D., Sandoval G.A., Murray M. (2008), Comparing patient reports about hospital care across a Canadian – US border, International Journal for quality in Health Care; Vol. 20 (2): 95 – 104. Bruster S, Jarman B, Bosanquet N, Weston D, Erens R, Delblanco T. (1994), National survey of hospital patients. BMJ; Vol. 309: 1542–6. Calnan M. (1988), Towards a conceptual framework of lay evaluation of health care. Soc Sci Med; Vol. 27: 927–33. Charles C., Gauld M., Chambers L., O'BrienB., Haynes R.B., Labelle R. (1994), How was your hospital stay? Patients' reports about their care in Canadian hospitals. CAN MED ASSOC J; Vol. 150 (11): 1813 – 1822. Cheng S., Yang M., Chiang T. (2003), Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care, International Journal for Quality in Health Care; Vol. 15 (4): 345-355. Cleary PD (1999), ‘The increasing importance of patient surveys’. British Medical Journal, Vol. 319: 720–1. Coulter A. (2006), Trends in patients’ experience of the NHS. Picker Institute Europe. Coulter A., Fitzpatrick R., Cornowell J. (2009), The point of care. Measures of patients’ experience in hospital: purpose, methods and uses. The King’s fund, July. Coulter A., Jenkinson J. (2005), European patients’ views on the responsiveness of health systems and healthcare providers. European Journal of Public Health; Vol. 15: 355-360. Crow R., Gage H., Hampson S., Hart J., Kimber A., Storey L., Thomas H. (2002), The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature, Health Technology Assessment; Vol. 6 (32).

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González N., Quintana J.M., Bilbao A., Escobar A., Aizpuru F., Thompson A., Esteban C., San Sebastián J. A., De La Sierra E. (2005), Development and validation of an in-patient satisfaction questionnaire, International Journal for Quality in Health Care; Vol. 17 (6): 465–472. Guldvog B. (1999), Can patient satisfaction improve health among patients with angina pectoris? International Journal for Quality in Health Care; 11: 233-240. Hudak P.L., McKeever P., Wright J.G. (2003), The metaphor of patient as customers: implication for measuring satisfaction, Journal of Clinical Epidemiology, Vol. 56: 103 – 108. Jenkinson C., Coulter A., Bruster S. (2002), The picker patient experience questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health care; Vol. 14: 353 – 358. Pilpel D. (1996), Hospitalized patients’ satisfaction with caregivers’ conduct and physical surroundings. J Gen Intern Med; Vol. 11: 312–14 Shackley P., Ryan M. (1994), What is the Role of the Consumer in Health Care? Journal of Social Policy, Vol. 23: 517-541. Sitzia J, Wood N. (1997), Patient satisfaction: a review of issues and concepts. Social, Science and Medicine; Vol. 45 (12): 1829-1843. Westaway M. S., Rheeder P., Van Zyl D. G., Seager J. R. (2003), Interpersonal and organizational dimensions of patient satisfaction: the moderating effects of health status. International Journal for Quality in Health Care, Vol. 15 (4): 337 – 344. World Health Organization (2000), The World Health Report 2000. Health Systems: improving performance. Geneva.

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Appendix A

Available instruments: the Warwick Patient Experience Network and Patient

Satisfaction Questionnaire (PSQ)

12

THE WARWICK PATIENT EXPERIENCE NETWORK _________________________________________________________________________________________

UK and US healthcare and academic institutions have developed survey instruments, which

are widely used beyond their respective borders. Two of these are included below,

together with abridged comments, which explain their meaning and use.

Developing and Implementing NICE Guidance on Patient Experience

Table of contents

1. Introduction

2. The need for guidance

3. Warwick Patient Experiences Framework

4. NICE Guidance

5. NICE Quality Standard

6. Importance of patient involvement in guideline development

7. Implementing the NICE guidance on patient experience

8. NICE Implementation Support

9. Collaborative patient and public involvement in implementation

10. Conclusions

11. References

Sophie Staniszewska, RCN Research Institute, University of Warwick, with Ian Bullock, Liz

Avital, Norma O’Flynn, National Clinical Guidelines Centre, Royal College of Physicians

Introduction

Patient experience has become a key component of good quality care, reflecting a long

tradition of research and policy initiatives, which have emphasised the importance of

patient-centred care.

The article considers the research and policy context that have driven patient experience

up the agenda, summarises the development of the Warwick Patient

Experience Framework, before presenting the development and discussing the

implementation of the NICE guidance and quality standards, which are published as Patient

Experience in Adult NHS Services: Improving the Experience of Care for People Using Adult

NHS Services.

13

The guidance and quality standards are the first of their type and as such represent a

landmark in the history of patient experience initiatives, with potential international

transferability to other healthcare providers.

Background

The development of interest in patient experience has a long history, originating in the

1950’s and 1960’s in the United States, the UK and other countries. Early studies explored

concepts such as patient satisfaction, less commonly used now to capture patient

evaluations of care, with its limitations more fully understood. 12345 The importance of

patient perspectives was recognised as early as 1974 by the eminent epidemiologist

Richard Doll, who emphasised the importance of evaluating the social acceptability of care,

alongside evaluations of clinical effectiveness and economic efficiency. He stated ‘There is

no point providing a health service that is effective and cheap, if no-one wants it,’

emphasising the importance of finding out what patients think about their care6. Early

research gradually expanded into a significant body of international research, which now

contains a range of approaches to evaluating patient experience7. As other papers in this

Journal demonstrate, patient experience as a field of research and practice has truly come

of age.

Although patient experience is recognised as important, conceptual and methodological

challenges exist. A common problem is the normative effect, where patients evaluate their

care positively, even when their care has been poor, leading to a possible underestimation

of such care. There is still an important need to develop instruments, which are able to

mitigate some of these social effects and so capture the full range of positive and negative

evaluations of care.8

Warwick Patient Experiences Framework

The development of the guidance included a review of existing patient

experience frameworks. It was not always clear how well patient experience frameworks

were supported by research evidence, or the extent to which the frameworks reflect

patient-identified experiences, as opposed to those identified by researchers and clinicians

(14, 16). As a result, a scoping study was commissioned to develop a framework with very

clear links to the evidence base, capturing generic themes and sub-themes of experiences

(for example, different aspects of information provision). The framework was then tested

14

for its validity and acceptability by the guideline development group, including six patient

representatives.

The scoping study aimed to:

• Identify generic themes and sub-themes of patient experience in three clinical areas:

cardiovascular disease, diabetes and cancer, all areas of significant disease burden.

• Use the themes and sub-themes identified in the three clinical areas to develop an

overall generic patient experiences framework that has relevance for all patients.

NICE then produced an evidence table of generic themes and sub-themes for each clinical

area. A thematic synthesis was carried out which drew the themes together into one

overarching generic framework (16). It is important to recognise that this scoping study was

a focused thematic qualitative overview, as a pragmatic review of the literature was needed

given the timescale of guideline development. Some elements of systematic reviewing were

adopted (for example, development of search strategies, identification of papers through

inclusion and exclusion criteria and extraction of data from papers (Centre for Reviews and

Dissemination Guidance 2009). The full methods and results are reported elsewhere (14,16).

Table 1 shows the key dimensions developed for the Warwick Patient Experiences

Framework.

Table 1 The Warwick Patient Experiences Framework:

Generic theme Patient as active participant Responsiveness of services - an individualised approach Continuity of care and relationshipsLived experience Communication Information Support

A full description of each dimension is included elsewhere (14,16). These themes provided

an architecture around which the content of the patient experience guideline was

developed. This is described more fully in the next section.

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NICE Guidance

To develop the guidelines, NICE recruited a Guideline Development Group (GDG) consisting

of healthcare professionals and patients . In developing the Patient Experiences Guidance,

the GDG drew on a range of evidence and information in order to establish what is

important to patients when considering their experience of healthcare (14). In addition to

the scoping study which produced the Warwick Patient Experience Framework, key sources

were:

1. Review of existing patient experience frameworks

2. Review of NHS survey results

3. Review of existing NICE recommendations related to patient experience

4. Systematic reviews of the literature on prioritised topic areas

Drawing on these sources, the GDG worked in collaboration to achieve consensus through

the development of specific recommendations which took into account:

• Existing NICE recommendations related to patient experience in the area they wish to

make generic recommendations

• Selected systematic literature reviews for specific interventions that may improve

patient experience (14)

See Figure 1 for a graphical representation of the synthesis of evidence, taken from NICE

Guidance.

16

Figure 1 A summary of evidence sources for the development of the Patient Experiences Guidance

17

Through a process of consensus, the GDG further refined the dimensions contained within

the Warwick Patient Experience Framework to generate the final high level themes, which

framed the Guidance to ensure it was structured in a way that focused on practical

recommendations for professionals. The dimensions in the NICE Guidance are:

• Knowing the patient as an individual

• Essential requirements of care

• Tailoring healthcare services for each patient

• Continuity of care and relationships

• Enabling patients to actively participate in their care

Within each of these dimensions, a set of recommendations was developed.

A detailed description of each of these dimensions and their accompanying

recommendations is contained in the Guidance (14). http://guidance.nice.org.uk/CG138

NICE Quality Standard

The quality standard defines best practice for the delivery of excellent patient experience.

The intention is to deliver specific, concise statements, measures and audience descriptors

to provide the public, health and social care professionals, commissioners and service

providers with definitions of high-quality care (14). By nature these statements are

aspirational. The aim of this quality standard is to provide the NHS with clear

commissioning guidance on the components of a good patient experience, embedding this

as a key priority within the commissioning outcomes framework. The quality standard gives

evidence-based statements for commissioners that provide the foundation for a cultural

shift towards a truly patient-centred service.

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Table 2. NICE Quality Standard on Patient Experiences

No. Quality statements 1 Patients are treated with dignity, kindness, compassion, courtesy, respect, understanding and

honesty. 2 Patients experience effective interactions with staff who have demonstrated competency in

relevant communication skills. 3 Patients are introduced to all healthcare professionals involved in their care, and are made

aware of the roles and responsibilities of the members of the healthcare team. 4 Patients have opportunities to discuss their health beliefs, concerns and preferences to inform

their individualised care. 5 Patients are supported by healthcare professionals to understand relevant treatment options,

including benefits, risks and potential consequences.6 Patients are actively involved in shared decision making and supported by healthcare

professionals to make fully informed choices about investigations, treatment and care that reflect what is important to them.

7 Patients are made aware that they have the right to choose, accept or decline treatment and these decisions are respected and supported.

8 Patients are made aware that they can ask for a second opinion. 9 Patients experience care that is tailored to their needs and personal preferences, taking into

account their circumstances, their ability to access services and their coexisting conditions. 10 Patients have their physical and psychological needs regularly assessed and addressed,

including nutrition, hydration, pain relief, personal hygiene and anxiety. 11 Patients experience continuity of care delivered, whenever possible, by the same healthcare

professional or team throughout a single episode of care.12 Patients experience coordinated care with clear and accurate information exchange between

relevant health and social care professionals. 13 Patients’ preferences for sharing information with their partner, family members and/or

carers are established, respected and reviewed throughout their care. 14 Patients are made aware of who to contact, how to contact them and when to make contact

about their ongoing healthcare needs.

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Importance of patient involvement in guideline development

The Patient and Public Involvement Programme (PPIP) at NICE provides advice and support

to NICE on patient, carer and public involvement. The PPIP currently works with NICE to

develop opportunities for involving patients, carers and members of the public across all

NICE’s work programmes. The Patient Experience Guidance Development Group included

six patient representatives, significantly more than usual in guideline development. While

NICE processes were followed, some elements were adapted. Because of the particular

focus of the guidance and the large number of patients involved, INVOLVE ways of working

were used to support the development of a collaborative and respectful working style,

which valued all contributions to the process.

Implementing the NICE guidance on patient experience

The existence of NICE Guidance on patient experience does not automatically guarantee

adoption and implementation. As Seers et al (17) state ‘despite significant investment,

translating research in to healthcare decision making and practice remains a considerable

challenge.’ Seers et al (17) point to numerous examples of attempts to implement evidence

into practice; with mixed success.

Such uneven progress in implementing evidence in practice relates to the complexity of the

process, which can involve change at many levels and depends on a range of factors that

can influence uptake (18). The complexity of implementation can be even more challenging

when, like the NICE Patient Experiences Guidance and Quality Standard, the guidance is

complex and contains an extensive range of required changes, including those at

individual, organisational and at professional level.

NICE Implementation Support

To support implementation, NICE has established a programme which works alongside

guideline developers, the communications team and field based teams to ensure the

guidance is disseminated throughout the NHS, local government and the wider community.

The Implementation team also provide tools to support implementation of NICE Guidance.

NICE produced a document which provides support for commissioners and others using

the NICE guidance and quality standard on patient experience in adult NHS services (19).

This provides information about patient experience, the policy context, why it is important,

20

how it can be measured and how commissioners can incorporate it into all aspects of

commissioning, including contract management, service delivery and incentive schemes.

NICE encourage commissioners to use the Patient Experience Guidance in a range of ways.

For example, it can be used as one of the factors used to judge tenders for services (19).

Commissioners could ask for evidence that demonstrates that the provider has systems in

place for collecting and using information about patient experience. Commissioners could

use some or all of the NICE guidance and quality statements in their contracts, and

stipulate the frequency for gathering and reporting measures with providers (19). NICE also

state that commissioners should audit local practice and can incentivise improvements to

patient experience by using the CQUIN scheme. They should ensure that all CQUIN

schemes have a focus on patient experience. Commissioners could also ensure that

providers collect information about patient experience across the whole service pathway,

from referral to post-discharge. Commissioners should also describe how to manage

examples of poor patient experience. Providers and commissioners ought to be made

aware of any problems so that they can take action to improve services (19).

Such support provides practical advice for embedding the NICE Guidance. Any

commissioner or provider involved in embedding the NICE Guidance within their

organisation must draw on the implementation evidence base in developing their strategy,

in recognition of the complexity involved in changing practice (17, 20-23). One way

forward would be to draw on existing implementation frameworks to provide a context for

thinking through key elements of an implementation strategy. A range of implementation

frameworks exist (20). One of the key frameworks is the Promoting Action on Research

Implementation in Health Services (PARIHS) framework, which demonstrates the complex

interplay of a number of factors that influence the successful implementation of evidence

in practice (20-23). Successful implementation is represented as a function of the nature of

evidence being implemented, the context in which implementation takes place, and the

way in which that process is facilitated. The PARIHS framework has been ‘used by others as

a heuristic to guide implementation efforts at the point of care delivery’(17) and so has

important applicability for the NICE Patient Experiences Guidance. Ideally, the PARIHS

framework would be used within a research study to test different ways of implementing

the NICE Patient Experiences Guidance, in order to identify the most effective forms of

implementation. In the absence of such formal research studies, the core thinking which

21

underpins the PARIHS framework may be useful for practitioners, commissioners and

providers when they plan their implementation strategy. Even being aware of the three

key concepts of the PARIHS framework, evidence, context and facilitation could provide an

initial conceptual structure to underpin the development of an implementation strategy.

Collaborative patient and public involvement in implementation

The NICE Patient Experience Guidance was developed on the basis of collaborative

involvement which aims to ensure true partnership and equal power in discussions and

decision-making at a local level, ensuring everyone has the opportunity to shape thinking

and debate. This approach can also be used in the implementation of research evidence or

guidance. We would propose a collaborative form of patient and public involvement is

used in the development of implementation strategies locally. Patients and patient

organisations have a vital role to play in developing such strategies and in implementing

them in a range of ways, including at an individual level when they have a consultation

with their doctor or nurse.

Conclusions

The NICE Patient Experience Guidance and Quality Standard provides a unique opportunity

to implement cultural, attitudinal and behavioural changes in healthcare provision, in order

to provide the best possible experience for all patients. We hope to encourage others to

contribute to the debate about the most effective forms of implementation and to work

together to create truly patient-centred care.

22

References

1. Carr-Hill R: The Measurement of Patient Satisfaction. J Pub Health Med

1992;14(3):236–49

2. Fitzpatrick R. Scope and Measurement of Patient Satisfaction. In: Fitzpatrick R, Hopkins

A, editors. Measurement of Patients’ Satisfaction with their Care. London: Royal College

of Physicians, 1993. p. 1–18.

3. Pascoe G. Patient Satisfaction in Primary Care: a Literature Review and Analysis. Eval

Prog Plann 1983;6:185–210.

4. Strasser S, Aharony L, Greenberger D. The Patient Satisfaction Process: Moving Toward

a Comprehensive Model. Med Care Rev 1993;50: 219–48.

5. Williams B. Patient Satisfaction: A Valid Concept? Soc Sci Med 1944;38:509–16

6. Doll R: Surveillance and Monitoring. Int J Epidemiol. 1974 Dec;3(4):305–314

7. Crow R, Gage H, Hampson S et al: The Measurement of Satisfaction with Healthcare:

Implications for Practice from a Systematic Review of the Literature. Health Technol

Assess 2002;6:1–244

8. Staniszewska S, Henderson L: The Complexity of Patient Evaluation – The Influence of

Contextual Factors and the Importance of Engagement. Journal of Advanced Nursing,

2005, 49 (6): 690-692.

23

THE PATIENT SATISFACTION QUESTIONNAIRE (PSQ) _________________________________________________________________________________________

The Patient Satisfaction Questionnaire (PSQ), consisting of 80 items, originally developed

by Ware and his colleagues (Ware, Snyder, and Wright, 1976), and a more recent version of

the questionnaire, i.e. the PSQ-III, are available below. The PSQ-III is a 50-item survey that

taps global satisfaction with medical care as well as satisfaction with six aspects of care:

technical quality, interpersonal manner, communication, financial aspects of care, time

spent with doctor, and accessibility of care.

More detailed information can be found at

http://www.qualitymeasures.ahrq.gov/content.aspx?id=26774,

including a note on scoring the PSQ-III. It provides background information, results of

psychometric analyses, and scoring rules for measures constructed from the periodic

satisfaction surveys.

The PSQ-18 is a short form version that retains many characteristics of its full-length

counterpart. The PSQ sub-scales show acceptable internal consistency reliability.

Furthermore, corresponding PSQ-18 and PSQ-III subscales are substantially correlate with

one another. The PSQ-18 may be appropriate for use in situations where the need for

brevity precludes administration of the full-length PSQ-III. The PSQ-18 takes approximately

3-4 minutes to complete.

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