Intended for healthcare professionals

Education And Debate Improving the quality of health care

Methods for incorporating patients' views in health care

BMJ 2003; 326 doi: (Published 19 April 2003) Cite this as: BMJ 2003;326:877
  1. Michel Wensing, senior researcher (,
  2. Glyn Elwyn, professorb
  1. a Centre for Quality of Care Research, University Medical Centre St Radboud, PO Box 9101, 6500 HB Nijmegen, Netherlands
  2. b Primary Care Research Group, University of Wales Swansea Clinical School, Swansea SA2 8PP
  1. Correspondence to: M Wensing

    This is the third of three articles on research into improving the quality of health care

    Efforts to improve health care will be wasted unless they reflect what patients want from the service. But to be sure that surveys of patients' views are valid and have an effect on care, the methods used must be evaluated rigorously

    Society now acknowledges the importance of the views of users in developing services, and the healthcare sector has used a range of methods to identify the views of patients and the public. Examples are questionnaires to assess patients' needs before a consultation with the clinician, shared decision making, focus groups with patients to include their views in clinical guidelines, and surveys among patients to provide feedback to care providers or the public. Such methods need to be examined in terms of validity, effectiveness, and implementation.1 We describe some of the important issues related to measuring patients' views and evaluating their use in improving health care.

    Summary points

    Patients can contribute to debates on health care by giving their preferences for care, evaluations of what occurred, or factual reports of care

    Measures of patients' views should be assessed for validity, preferably by rigorous qualitative studies

    Methods to include patients' views must be shown to affect the processes and outcomes of health care; possible negative consequences should also be considered

    Types of measures

    The methods used to determine patients' views can be divided into three types: measures of preferences, evaluations by users, and reports of health care (box). The types of measure used will depend on what aspect of health care is being assessed, but all have limitations.


    One problem with assessing preferences is that patients' decisions about what is important in health care often reflect their individual experience rather than a general view. Interaction between patients in focus …

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