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The Picker Patient Experience Questionnaire (PPE-15)

See the PPE-15: Link to the measure within the original published article

The PPE-15 is a 15-item patient experience questionnaire designed for use in inpatient care settings by Jenkinson, Coulter, and Bruster (2002). It can be used for both planned and emergency inpatient settings. It is a short form version of the Picker Adult In-Patient Questionnaire, which was developed by the Picker Institute. It was developed to identify patient experiences and problems with specific health care processes that affect the quality of care in inpatient settings. It contains specific questions about whether specific processes and events occurred during the patient’s care episode. It is free to use. It is a reliable and valid measure for use in inpatient settings. The questions can be incorporated into other inpatient surveys as part of routine data collection, allowing the comparison of scores over time. Such additional questions could include locally relevant questions, e.g., mode of admission, demographics questions and condition-specific questions. This incorporation into locally developed questions will help to improve relevance the PPE-15 responses to your service. Patients can complete this measure in their own time, so clinic time should not be affected by this measure’s use. It should take patients approximately 19 minutes to complete. While it was developed for use with doctors and nurses, it is likely that this measure can be used in the majority of inpatient settings. Look at the items in the questionnaire and use your clinical judgement to decide if it is a useful measure for your service. If you are working in an outpatient setting the PEQ is more suitable.

How to collect the data
The PPE-15 should be given to patients after they have been discharged from inpatient care. It may be easiest to post this to patients within one month of discharge. Including stamped addressed envelopes for returning the questionnaire will increase your return rate but will also add an additional cost – you must decide which is the priority: a high return rate or keeping costs low. A covering letter explaining why you are asking them the questions can be included (e.g., that you are interested in learning of their experience of care in order to improve future service, or similar) and may encourage patients to complete and return the PPE-15. As patients complete and return the PPE-15 in their own time, you should consider sending a reminder postcard to them after 3 weeks if you have not received their completed questionnaire. If you do not receive the completed questionnaire within a few weeks after the reminder being sent you can either re-send the questionnaire or you can conclude that they will not return the questionnaire and not send any further questionnaires to that patient. This is something that you should decide prior to starting the project and you should be consistent with all patients in the procedure that you take.

How much data do you need to collect?
The PPE-15 uses a simple scoring system that is explained in the next section. Because it is a flexible and simple measure of patient experience, no minimum number of responses has been recommended by the authors. However, as with all patient surveys or research projects, a reasonable number of representative sample of patients should complete the PPE-15 in order to allow a fuller and proper view of the service you are providing. There are no minimum number of measures recommended to collect, but you should endeavour that you get enough completed to give you a representative understanding of your patients views.

What to do with your raw data – scoring the measure
The authors of the PPE-15 recommend a simple summing of the responses to the 15 questions. For the questions there are either three or four possible responses (these can be found in more detail here), which are generally as follows:

  • Yes, always
  • Yes, sometimes
  • No
  • Not relevant (different variations of this)

 When you have all of your questionnaires you basically count how many of each response you have. So, for example, if you have 50 completed questionnaires you would count up the number of patients who have responded ‘yes, always’ to question 1, and the number who have responded ‘yes, sometimes’, ‘no’, and ‘not relevant’. Do this for each of the 15 items to give you an idea of the pattern of responses. It can be helpful to graph the responses (the percentages of the responses) to give you an easily interpreted idea of the spread of the responses. Graphing and reporting percentages may be more useful in terms of comparing your findings with those of other services and across time.

The PPE-15 authors also recommend summing the total number of yes-type responses, no-type responses, and not relevant-type responses for all of the 15 questions to get an overall picture of the patients’ experience of the care received. Again, graphing the percentages could be useful. To do this, score each question as follows: 1 for a ‘yes, always’ or ‘yes, sometimes’ response; 0 for a ‘no’ response. After doing this for your 15 questions you simply add up the total. This will give you a minimum score of 0 (no problems) and a maximum of 15 (high level of problems). If you are collecting a large number of these (so, from more than one patient) you should work out your average score.

Interpreting your findings
No table of normative values exist for the PPE-15, so we cannot present cut-off scores on which to judge how you or your service has done. However, the logical scoring of the questionnaire does allow you to identify where there are problems. If you have, for example, a majority of ‘yes’ responses to a particular question in the PPE-15, then this would indicate that you have a problem with that element of the patient experience. In that case you would need to make an improvement plan to address the problem. On the other hand, if the majority of patients are responding ‘no’ to the questions then you can take this as a good indicator that you do not have a problem with those elements of the patient experience.

As mentioned in the earlier section, putting your responses into graphs (a bar graph or a pie chart would be best) will help you to visualise where the problems are and what areas of service need to be improved.

In terms of interpreting the whole scale, again, looking at the overall number of ‘yes’ responses versus ‘no’ responses will give you an idea of the overall picture. Again, a majority of ‘yes’ responses indicates that there are problems that need to be addressed and ‘no’ responses indicate that there are no problems with the service. However, we strongly recommend that you use this overall rating as an indication only. In order to get clinically meaningful information from the PPE-15 you should look at the responses to each of the fifteen questions.

Keep a record of your findings. This will enable you to make comparisons over time and to identify trends.

Reporting your findings
See also Stage 5: Reporting Outcomes

For the PPE-15 we recommend that you graph the responses to the 15 questions to give an immediate visualisation of the spread of your data. This will allow you and other staff or managers to immediately grasp the areas where improvement is required. Graphing the percentages of responses is better as it will allow you to compare results from different times without worrying about how many responses were collected at each time-point.

After each graph you should comment on your findings too. To make the reporting of information easier for you we suggest that you use the following template to report your findings. This is not the whole story, however, just a small part of it. You should still continue on to Stages 5 and 6 to best report your findings and to move onto the next stages (e.g., acting on your findings).

Patient experience was measured using the Picker Patient Experience Questionnaire (PPE-15). This questionnaire highlights problems that the patient has experienced with health care processes during their stay in our inpatient care. The findings to each of the questions are graphed below for ease of reading.

_*put graphs in – don’t make them too large or too colourful, the easier to see the better*_

Underneath each graph: As shown in the graph the majority of patients responded ‘yes/no’ to the question ‘_*put question here*_’. This indicates that there is/is not a problem with this element of the patient experience.

If there is not a problem: As no problem in this aspect of patient experience is reported we will continue to deliver high levels of patient care in this area.

If there is a problem: In order to address this issue, the following actions will be taken. _*Describe improvement plan*_.

If you have collected data using the PPE-15 before: The finding in the graph above shows that this element of the patient experience has improved/declined since our last measurement on _*date of last survey*_. We will continue to strive to improve the service based on these findings.

Relevant Publications
Jenkinson, C., Coulter, A. & Bruster, S. (2002). The Picker Patient Experience Questionnaire: Development and validation using data from in-patient surveys in five countries. International Journal for Quality in Health Care, 14(5), 353-358.

Relevant links
Information on improving patient experience

Copyright/Intellectual property rights
See: Jenkinson, C., Coulter, A. & Bruster, S. (2002). The Picker Patient Experience Questionnaire: Development and validation using data from in-patient surveys in five countries. International Journal for Quality in Health Care, 14(5), 353-358.

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