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Debunking myths about patient experience surveys

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Patient experience surveys are commonplace in UK hospitals and care settings. Here, Marc Elliott and Rebecca Anhang Price consider seven myths about the relevance and fairness of this practice and question how they really contribute to service improvement and patient satisfaction. 

Patient experience measures are being publicly reported in increasing numbers and included in pay-for-performance programmes, but critics express concern about the relevance and fairness of using information from patient experience surveys as indicators of healthcare quality. In an article entitled, Should Health Care Providers Be Accountable for Patients' Care Experiences?, published in the Journal of General Internal Medicine (Feb 2015), we debunked a selection of the most prevalent myths:

  • Myth #1: Patients don’t have the expertise to answer questions about the quality of their healthcare. Surveys used in public reporting such as the consumer assessment of healthcare providers and systems (CAHPS) surveys in the US and the GP patient survey (GPPS) in the UK ask about patient experience, not technical quality of care. And patients are the best and only source of that information.
  • Myth #2: Patient experience is too subjective to be actionable. Good patient surveys measure specific care experiences, like whether the healthcare provider communicated in a way that the patient understood. Information from such surveys can help to identify aspects of care that could be changed to improve patient experience.
  • Myth #3: Emphasising patient survey results encourages providers to meet patient expectations for their care, rather than to provide appropriate care. Research suggests that patients value how well their provider communicates more than whether he or she offers a specific treatment. [1] Making sure that patients are involved in treatment plans is another way to improve patients’ ratings of their care experiences. [2]

'Patients are the best and only source of patient experience information.'

  • Myth #4: There is a tradeoff between good patient experiences and high quality clinical care. There’s no tradeoff. Dozens of studies have found either positive or no association between ratings of patient experience and ratings of clinical quality, suggesting that it’s possible for healthcare providers to simultaneously offer better patient experiences and better clinical quality. [3]
  • Myth #5: It’s not fair to compare patient experience scores across healthcare providers or health plans because some factors beyond their control can affect their scores. It’s true that factors like deprivation can affect patient experience scores. But such differences can be accounted for by a statistical technique called case-mix adjustment, which makes it possible to estimate how providers would score if they all served the same patients. Case-mix adjustment levels the playing field. [4][5] 
  • Myth #6: Only patients who have very good or very bad experiences take the surveys, so the results are biased. Although the possibility of bias is important to remember, studies have not found evidence that response rates bias comparisons of case-mix adjusted patient experience scores.
  • Myth #7: There are faster, cheaper, and more customised ways to gather information about patient experiences. Patients may find approaches such as online reviews less burdensome, and providers might see customised surveys as more immediately relevant for quality improvement than standardised surveys such as CAHPS or GPPS. But making fair comparisons between practices, providers, or plans requires standardised and consistent measurement such as that provided by the CAHPS or GPPS surveys.

Patient experience with care is an essential element in any assessment of healthcare quality. Patient experience surveys give patients a voice, and – when conducted and analysed according to rigorous standards – provide fair and relevant indicators that complement other metrics of healthcare quality to monitor and improve care.


  1. Kravitz RL. Patients' expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev 1996;53(1):3-27.
  2. Shah MB, Bentley JP, McCaffrey DJ, 3rd. Evaluations of care by adults following a denial of an advertisement-related prescription drug request: the role of expectations, symptom severity, and physician communication style. Soc Sci Med 2006;62(4):888-99. 
  3. Anhang Price R, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, Edgman-Levitan S, & Cleary PD. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev 2014;71(5):522-54.
  4. Zaslavsky AM, Zaborski LB, L. D, Shaul JA, Cioffi MJ, Cleary PD. Adjusting performance measures to ensure equitable plan comparisons. Health Care Financ Rev 2001;22(3):109-26.
  5. Hargraves JL, Wilson IB, Zaslavsky A, James C, Walker JD, Cleary PD. Adjusting for patient characteristics when analyzing reports from patients about hospital care. Med Care 2001;39(6):635-41.