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Specifically Developed Question

Specifically developed questions about your patients’ experience have been found to be quite sensitive (e.g., Chew et al., 2004; Chew et al., 2008).

These single questions can be locally developed to be relevant to your own service, or you can use one of the questions (which have been researched) suggested below. These individual questions are not a validated measure of patient experience, and, as they are individual, cannot be tested for statistical reliability. However, they are free to use, easily adapted to suit your specific purpose, quick to ask and to interpret, and easily understood by stakeholders.

Specifically developed questions are a good measure to use if you are short of time with patients or if you would like to run a pilot or precursor study to assess the need for a fuller audit of patient experience using one of the validated measures.

They can help you to quickly identify where a particular service could improve the patient experience it delivers. That is, if many patients report that they are not happy or would not recommend the service to others, for example, the patients’ experience of the service could be clearly improved and a fuller patient experience audit should be carried out. Using the specifically developed questions in this way can help to save time, money and effort as a ‘full’ patient experience audit using the validated measures may not always be required.

However, when using these specifically developed questions to assess patient experience, you must be careful not to simply ask about patient satisfaction. It has been well demonstrated that the majority of patients will say that they are satisfied with a service overall, even if there are particular elements of the service that they are unhappy with.

How to collect the data
You must first either select a question from those identified from the published research in this area (see below) or develop a question relevant to you local patient experience. It is best with these specifically developed questions to give a forced choice (e.g., yes or no) or a scaled response (e.g. from 0-5) system.

At the end of each consecutive consultation, you should ask patients your selected question and record their answer. Do this for a pre-arranged period of time (e.g., 1 month) or until a specific number of patients have responded (e.g., 100 patients).

You can also ask the question at a second time-point (e.g., following an intervention) to assess change in the patient experience. This would be a very blunt measure, but a quick, cost-effective and simple one to do. If doing this, the wording of response scale options should be identical at each time-point.

Example Questions:

  • Would you recommend this service to friends or family?
    • ‘yes or no’ response
    • This is a standard question often used to assess patient experience

  • Were you given enough privacy when discussing your condition or treatment?
    • ‘yes, always; yes, sometimes; no’ responses
    • Developed by the Picker institute (2002). See the following for more examples and details: Picker Institute. (2002). Picker Institute Europe. 2002.

  • How often do you have problems learning about your medical condition because of difficulties understanding written information?
    • 0-4 rating scale; none of the time-all of the time
    • This will help you to determine whether your patients’ experiences of the service are being held back by poor literacy. Identifying this problem can help to improving their overall experience of the service and effectiveness of the treatment though improving their understanding about their condition (they are more likely to follow your treatment and guidance if they understand why, thereby improving the treatment’s effectiveness).
    • Developed by Chew, Bradley, and Boyco (2004). Chew and colleagues (2008) have two other health literacy questions similar to this one in their paper ‘Validation of screening questions for limited health literacy in a large VA outpatient population’ (see Relevant Publications, below).

How much data do you need to collect?
As this is a non-validated, blunt measure of patient experience, there are no strict guidelines on how much data to collect. However, before beginning you should either: 

  • Pre-determine a specific time-period to ask the question to patients. This should be long enough to obtain a reasonably large patient response. So if you have a high patient caseload then perhaps two weeks would be suitable; a lower caseload may require 1 month of data collection.

  • Pre-determine a specific number of patient responses. This number should be reflective of your overall patient caseload. Aim to collect for as large a number of patients as feasibly possible. Ideally around 50-100 responses.

Regardless of which of the options above you use, you should ask all consecutive patients your selected question. Do not self-select which patients to ask – this would give you an inaccurate picture of your service.

Do not use more than (or at the most two) of these specifically developed questions – this would become a non-validated questionnaire. It would then be better if you use one of the validated patient experience questionnaires.

What to do with your raw data – scoring the measure and interpreting your findings
As you are using a very simple response scale (only one question with a set response option) you are best to simply graph the number or the percentage of responses on each of the response options. So if you are using a ‘yes or no’ question, graph the number of ‘yes’ responses and the number of ‘no’ responses. You can do the same for scaled (e.g., 0-5 responses).

You should be able to interpret the responses to the questions quite easily, as you have decided on the question and on the response scale. As the question asked will be very individual to each service we will not be presenting a template for reporting your findings. See Stage 5: Reporting Outcomes for guidance.

Relevant Publications
Chew, L.D., Bradley, K.A., & Boyko, E.J. (2004). Brief questions to identify patients with inadequate health literacy. Family Medicine, 36(8), 588–94.

Chew, L.D., Griffin, J.M., Partin, M.R., Noorbaloochi, S., et al. (2008). Validation of screening questions for limited health literacy in a large VA outpatient population. Journal of General Internal Medicine, 23(5), 561-566.

Derose, S.F., & Petitti, D.B. (2003). Measuring quality of care and performance from a population health care perspective. Annual Review of Public Health,24, 363-384.

Picker Institute. (2002). Picker Institute Europe. 2002.

Relevant links 
Information on improving patient experience.

You have reached the end of the guidance for this measure.  Move onto Stage 5: Reporting Outcomes.

Or go back to Stage 3: Considering Options to review other measures.


© Copyright 2012 NMAHP RU, Stirling University