Now that sound methods exist, patient surveys can facilitate improvement

People often think of “exit” and “voice” as the main ways patients can influence healthcare quality1—that is, patients can leave providers they are not happy with or they can voice their opinions in an attempt to change care. A common strategy for eliciting patients' “voices” is to conduct surveys. Clinicians have long been sceptical about such surveys, partly because they communicate regularly with their patients and saw no need for another method of hearing their concerns and partly because satisfaction surveys used to be flawed measures of healthcare quality. Now, however, that is beginning to change as rigorous methods have been applied to developing and evaluating patient surveys.

Despite numerous studies of patient satisfaction,2 they have not resulted in the quality improvement that many expected. Previous satisfaction surveys had little impact because they often did not meet minimal standards of conceptual or methodological rigour and were not designed to facilitate quality improvement efforts. Responses to such surveys are subjective and difficult to interpret since …