Gestão & Produção
Gestão & Produção
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Instruments to measure patient experience in hospitals: a scoping review

Juliana Maria Savio Bernardo; Glauco Henrique de Sousa Mendes; Fabiane Letícia Lizarelli; Meliza Goi Roscani

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Abstract:: Patient experience (PE) has been associated with patients' perception of care services, organizational culture, and interactions experienced by patients. This article aims to characterize the process of measuring adult PE in general hospitals. Therefore, a scoping review (Scoping Review) in a sample of 51 empirical articles dealing with the assessment of PE was analyzed. The results show the predominance of quantitative PE measurement methods. HCAHPS is the most used instrument to evaluate PE. It was also possible to identify the attributes and dimensions (independent variables) considered in the PE measurement. In this case, the relational aspects between patients and health professionals have received great attention in the PE. Measures such as patient experience, satisfaction, quality, and loyalty have been used as PE outcomes (dependent variables). The article contributes to understanding the operationalization and measurement of PE by emphasizing the attributes and dimensions that have been considered in PE measurement, which can be useful for researchers and healthcare professionals interested in evaluating and identifying discrepancies in healthcare services.


Patient experience, Measurement, Hospital, Scoping review


Agency for Healthcare Research and Quality – AHRQ. (2018). Updates to all documents pertaining to april 2018 Public report and the pain management composite. Retrieved in 2018, June 15, from

Ahmed, F., Burt, J., & Roland, M. (2014). Measuring patient experience: concepts and methods. The Patient-Patient-Centered Outcomes Research, 7(3), 235-241. PMid:24831941.

Alaloul, F., Myers, J., Masterson, K. M., DiCicco, J., Perry Collins, M., Hogan, F., Roesler, L., & Logsdon, M. C. (2019). Patient experience factors and health-related quality of life in hospitalized individuals. Oncology Nursing Forum, 46(2), 238-247. PMid:30767955.

Alástico, G. P., & Toledo, J. C. D. (2013). Acreditação Hospitalar: proposição de roteiro para implantação. Gestão & Produção, 20(4), 815-831.

Arksey, H., & O'Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19-32.

Banka, G., Edgington, S., Kyulo, N., Padilla, T., Mosley, V., Afsarmanesh, N., Fonarow, G. C., & Ong, M. K. (2015). Improving patient satisfaction through physician education, feedback, and incentives. Journal of Hospital Medicine, 10(8), 497-502. PMid:26014339.

Beattie, M., Murphy, D. J., Atherton, I., & Lauder, W. (2015). Instruments to measure patient experience of healthcare quality in hospitals: a systematic review. Systematic Reviews, 4(1), 97. PMid:26202326.

Beattie, M., Shepherd, A., Lauder, W., Atherton, I., Cowie, J., & Murphy, D. J. (2016). Development and preliminary psychometric properties of the Care Experience Feedback Improvement Tool (CEFIT). BMJ Open, 6(6), e010101. PMid:27301482.

Brown, S. M., McBride, G., Collingridge, D. S., Butler, J. M., Kuttler, K. G., Hirshberg, E. L., Jones, J. P., Hopkins, R. O., Talmor, D., & Orme, J. (2015). Validation of the Intermountain patient perception of quality (PPQ) survey among survivors of an intensive care unit admission: a retrospective validation study. BMC Health Services Research, 15(1), 155. PMid:25889073.

Bruyneel, L., Tambuyzer, E., Coeckelberghs, E., De Wachter, D., Sermeus, W., De Ridder, D., Ramaekers, D., Weeghmans, I., & Vanhaecht, K. (2017). New instrument to measure hospital patient experiences in flanders. International Journal of Environmental Research and Public Health, 14(11), 1319. PMid:29084160.

Bull, C. (2021). Patient satisfaction and patient experience are not interchangeable concepts. International Journal for Quality in Health Care, 33(1), mzab023.

Bustamante, J. C., & Rubio, N. (2017). Measuring customer experience in physical retail environments. Journal of Service Management, 28(5), 884-913.

Caneiras, C., Jácome, C., Mayoralas-Alises, S., Ramon Calvo, J., Almeida Fonseca, J., Escarrabill, J., & Winck, J. C. (2019). Patient experience in home respiratory therapies: where we are and where to go. Journal of Clinical Medicine, 8(4), 555. PMid:31022916.

Carter, J., Ward, C., Wexler, D., & Donelan, K. (2018). The association between patient experience factors and likelihood of 30-day readmission: a prospective cohort study. BMJ Quality & Safety, 27(9), 683-690. PMid:29146680.

Chan, B., Goldman, L. E., Sarkar, U., Schneidermann, M., Kessell, E., Guzman, D., Critchfield, J., & Kushel, M. (2015). The effect of a care transition intervention on the patient experience of older multi-lingual adults in the safety net: results of a randomized controlled trial. Journal of General Internal Medicine, 30(12), 1788-1794. PMid:25986136.

Cowen, M. E., Czerwinski, J., Kabara, J., Blumenthal, D. U., Kheder, S., & Simmons, S. (2016). The risk‐outcome‐experience triad: mortality risk and the hospital consumer assessment of healthcare providers and systems survey. Journal of Hospital Medicine, 11(9), 628-635. PMid:27251217.

Doyle, C., Lennox, L., & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open, 3(1), e001570. PMid:23293244.

Drennan, J., Duffield, C., Scott, A. P., Ball, J., Brady, N. M., Murphy, A., Dahly, D., Savage, E., Corcoran, P., Hegarty, J., & Griffiths, P. (2018). A protocol to measure the impact of intentional changes to nurse staffing and skill‐mix in medical and surgical wards. Journal of Advanced Nursing, 74(12), 2912-2921. PMid:30019346.

Fisher, K. A., Smith, K. M., Gallagher, T. H., Huang, J. C., Borton, J. C., & Mazor, K. M. (2019). We want to know: patient comfort speaking up about breakdowns in care and patient experience. BMJ Quality & Safety, 28(3), 190-197. PMid:30269059.

Forcino, R. C., Barr, P. J., O’Malley, A. J., Arend, R., Castaldo, M. G., Ozanne, E. M., Percac-Lima, S., Stults, C. D., Tai-Seale, M., Thompson, R., & Elwyn, G. (2018). Using Collabo RATE, a brief patient‐reported measure of shared decision making: results from three clinical settings in the United States. Health Expectations, 21(1), 82-89. PMid:28678426.

Garrard, F., & Narayan, H. (2013). Assessing obstetric patient experience: a SERVQUAL questionnaire. International Journal of Health Care Quality Assurance, 26(7), 582-592. PMid:24167918.

Gillam, S. W., Gillam, A. R., Casler, T. L., & Curcio, K. (2016). Education for medications and side effects: a two part mechanism for improving the patient experience.Applied Nursing Research, 31, 72-78.

Giordano, L. A., Elliott, M. N., Goldstein, E., Lehrman, W. G., & Spencer, P. A. (2010). Development, implementation, and public reporting of the HCAHPS survey. Medical Care Research and Review : MCRR, 67(1), 27-37. PMid:19638641.

Heyworth, L., Rozenblum, R., Burgess, J. F., Jr., Baker, E., Meterko, M., Prescott, D., Neuwirth, Z., & Simon, S. R. (2014). Influence of shared medical appointments on patient satisfaction: a retrospective 3-year study. Annals of Family Medicine, 12(4), 324-330. PMid:25024240.

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. PMid:12389801.

Jenkinson, C., Coulter, A., Reeves, R., Bruster, S., & Richards, N. (2003). Properties of the Picker Patient Experience questionnaire in a randomized controlled trial of long versus short form survey instruments. Journal of Public Health Medicine, 25(3), 197-201. PMid:14575193.

Kandampully, J., Zhang, T. C., & Jaakkola, E. (2018). Customer experience management in hospitality. International Journal of Contemporary Hospitality Management, 30(1), 21-56.

Kaneko, M., Aoki, T., Mori, H., Ohta, R., Matsuzawa, H., Shimabukuro, A., Motomura, K., & Inoue, M. (2019). Associations of patient experience in primary care with hospitalizations and emergency department visits on isolated islands: a prospective cohort study. The Journal of Rural Health, 35(4), 498-505. PMid:30550635.

Kashif, M., Samsi, S. Z. M., Awang, Z., & Mohamad, M. (2016). EXQ: measurement of healthcare experience quality in Malaysian settings. International Journal of Pharmaceutical and Healthcare Marketing, 10(1), 27-47.

Keller, S., O’Malley, A. J., Hays, R. D., Matthew, R. A., Zaslavsky, A. M., Hepner, K. A., & Cleary, P. D. (2005). Methods used to streamline the CAHPS® hospital survey. Health Services Research, 40(6p2), 2057-2077.

Kemp, K. A., Santana, M. J., Southern, D. A., McCormack, B., & Quan, H. (2016). Association of inpatient hospital experience with patient safety indicators: a cross-sectional, Canadian study. BMJ Open, 6(7), e011242. PMid:27371554.

Kerezoudis, P., Alvi, M. A., Ubl, D. S., Hanson, K. T., Krauss, W. E., Meyer, F. B., Spinner, R. J., Habermann, E. B., & Bydon, M. (2018). The impact of spine disease, relative to cranial disease, on perception of health and care experience: an analysis of 1484 patients in a tertiary center. Journal of Neurosurgery, 129(6), 1630-1640. PMid:29372876.

Klaus, P. P., & Maklan, S. (2013). Towards a better measure of customer experience. International Journal of Market Research, 55(2), 227-246.

Kuis, E. E., & Goossensen, A. (2017). Evaluating care from a care ethical perspective: a pilot study. Nursing Ethics, 24(5), 569-582. PMid:26811395.

Lane, J. V., Hamilton, D. F., MacDonald, D. J., Ellis, C., & Howie, C. R. (2016). Factors that shape the patient’s hospital experience and satisfaction with lower limb arthroplasty: an exploratory thematic analysis. BMJ Open, 6(5), e010871. PMid:27217282.

Larsson, B. W., & Larsson, G. (2002). Development of a short form of the Quality from the Patient’s Perspective (QPP) questionnaire. Journal of Clinical Nursing, 11(5), 681-687. PMid:12201896.

Larsson, G., Larsson, B. W., & Munck, I. M. (1998). Refinement of the questionnaire ‘quality of care from the patient’s perspective’using structural equation modelling. Scandinavian Journal of Caring Sciences, 12(2), 111-118. PMid:9801632.

LaVela, S. L., & Gallan, A. (2014). Evaluation and measurement of patient experience. Patient Experience Journal, 1(1), 28-36.

Lawton, R., O’Hara, J. K., Sheard, L., Reynolds, C., Cocks, K., Armitage, G., & Wright, J. (2015). Can staff and patient perspectives on hospital safety predict harm-free care? An analysis of staff and patient survey data and routinely collected outcomes. BMJ Quality & Safety, 24(6), 369-376. PMid:25862755.

Leggat, S. G., Karimi, L., & Bartram, T. (2017). A path analysis study of factors influencing hospital staff perceptions of quality of care factors associated with patient satisfaction and patient experience. BMC Health Services Research, 17(1), 739. PMid:29145847.

Levine, R. E., Fowler, F. J., Jr., & Brown, J. A. (2005). Role of cognitive testing in the development of the CAHPS® hospital survey. Health Services Research, 40(6p2), 2037-2056.

Liu, C., Wu, Y., & Chi, X. (2017). Relationship preferences and experience of primary care patients in continuity of care: a case study in Beijing, China. BMC Health Services Research, 17(1), 585. PMid:28830507.

Lusilla-Palacios, P., & Castellano-Tejedor, C. (2017). Acute spinal cord injury patients’ satisfaction with care: results from an intervention study in a specialized rehabilitation unit. Journal of Health Psychology, 22(10), 1289-1299. PMid:26837691.

Macinati, M. S. (2008). The relationship between quality management systems and organizational performance in the Italian National Health Service. Health Policy, 85(2), 228-241. PMid:17825941.

Maklan, S. (2012). EXQ: a multiple‐item scale for assessing service experience. Journal of Service Management, 23(1), 5-33.

Male, L., Noble, A., Atkinson, J., & Marson, T. (2017). Measuring patient experience: a systematic review to evaluate psychometric properties of patient reported experience measures (PREMs) for emergency care service provision. International Journal for Quality in Health Care, 29(3), 314-326. PMid:28339923.

Malik, N., Alvaro, C., Kuluski, K., Wilkinson, A. J., & Hurst, K. (2016). Measuring patient satisfaction in complex continuing care/rehabilitation care. International Journal of Health Care Quality Assurance, 29(3), 324-336. PMid:27120509.

Mbama, C. I., & Ezepue, P. O. (2018). Digital banking, customer experience and bank financial performance. International Journal of Bank Marketing, 36(2), 230-255.

McColl-Kennedy, J. R., Gustafsson, A., Jaakkola, E., Klaus, P., Radnor, Z. J., Perks, H., & Friman, M. (2015). Fresh perspectives on customer experience. Journal of Services Marketing, 29(6-7), 430-435.

McFarlan, S., O’Brien, D., & Simmons, E. (2019). Nurse-leader collaborative improvement project: improving patient experience in the emergency department. Journal of Emergency Nursing: JEN, 45(2), 137-143. PMid:30591243.

McLean, C., Griffiths, P., Mesa–Eguiagaray, I., Pickering, R. M., & Bridges, J. (2017). Reliability, feasibility, and validity of the quality of interactions schedule (QuIS) in acute hospital care: an observational study. BMC Health Services Research, 17(1), 380. PMid:28569151.

Mendes, G. H. D. S., & Mirandola, T. B. D. S. (2015). Acreditação hospitalar como estratégia de melhoria: impactos em seis hospitais acreditados. Gestão & Produção, 22(3), 636-648.

Mendes, G. H., Oliveira, M. G., Gomide, E. H., & Nantes, J. F. D. (2017). Uncovering the structures and maturity of the new service development research field through a bibliometric study (1984-2014). Journal of Service Management, 28(1), 182-223.

Merlino, J. I., Kestranek, C., Bokar, D., Sun, Z., Nissen, S. E., & Longworth, D. L. (2014). HCAHPS survey results: impact of severity of illness on hospitals’ performance on HCAHPS survey results. Journal of Patient Experience, 1(2), 16-21. PMid:28725804.

Meyer, C., & Schwager, A. (2007). Understanding customer experience. Harvard Business Review, 85(2), 116-126, 157. PMid:17345685.

Mosavi, S. M., Sangari, M. S., & Keramati, A. (2018). An integrative framework for customer switching behavior. Service Industries Journal, 38(15-16), 1067-1094.

Murrells, T., Robert, G., Adams, M., Morrow, E., & Maben, J. (2013). Measuring relational aspects of hospital care in England with the ‘Patient Evaluation of Emotional Care during Hospitalisation’(PEECH) survey questionnaire. BMJ Open, 3(1), e002211. PMid:23370012.

O’Malley, A. J., Zaslavsky, A. M., Hays, R. D., Hepner, K. A., Keller, S., & Cleary, P. D. (2005). Exploratory factor analyses of the CAHPS® hospital pilot survey responses across and within medical, surgical, and obstetric services. Health Services Research, 40(6p2), 2078-2095.

Oltedal, S., Garratt, A., Bjertnæs, Ø., Bjørnsdottìr, M., Freil, M., & Sachs, M. (2007). The NORPEQ patient experiences questionnaire: data quality, internal consistency and validity following a Norwegian inpatient survey. Scandinavian Journal of Public Health, 35(5), 540-547. PMid:17852989.

Otani, K., Buchanan, P. R., Desai, S. P., & Herrmann, P. A. (2016). Different combining process between male and female patients to reach their overall satisfaction. Journal of Patient Experience, 3(4), 145-150. PMid:28725851.

Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). Servqual: a multiple-item scale for measuring consumer perc. Journal of Retailing, 64(1), 12.

Peterson, J., Pearce, P. F., Ferguson, L. A., & Langford, C. A. (2017). Understanding scoping reviews: Definition, purpose, and process. Journal of the American Association of Nurse Practitioners, 29(1), 12-16. PMid:27245885.

Pettersen, K. I., Veenstra, M., Guldvog, B., & Kolstad, A. (2004). The Patient Experiences Questionnaire: development, validity and reliability. International Journal for Quality in Health Care, 16(6), 453-463. PMid:15557355.

Pine, B. J., 2nd, & Gilmore, J. H. (1998). Welcome to the experience economy. Harvard Business Review, 76(4), 97-105. PMid:10181589.

Pottenger, B. C., Davis, R. O., Miller, J., Allen, L., Sawyer, M., & Pronovost, P. J. (2016). Comprehensive unit-based safety program (CUSP) to improve patient experience: how a hospital enhanced care transitions and discharge processes. Quality Management in Health Care, 25(4), 197-202. PMid:27749716.

Rao, K. D., Peters, D. H., & Bandeen-Roche, K. (2006). Towards patient-centered health services in India: a scale to measure patient perceptions of quality. International Journal for Quality in Health Care, 18(6), 414-421. PMid:17012306.

Rapport, F., Hibbert, P., Baysari, M., Long, J. C., Seah, R., Zheng, W. Y., Jones, C., Preece, K., & Braithwaite, J. (2019). What do patients really want? An in-depth examination of patient experience in four Australian hospitals. BMC Health Services Research, 19(1), 38. PMid:30646962.

Reeves, R., Coulter, A., Jenkinson, C., Cartwright, J., Bruster, S., & Richards, N. (2002). Development and pilot testing of questionnaires for use in the acute NHS trust inpatient survey programme. Oxford: Picker Institute.

Rodrigues, K. C. (2019). A era da experiência dos pacientes. GV EXECUTIVO, 18(1), 16-19.

Roseen, E. J., Cornelio-Flores, O., Lemaster, C., Hernandez, M., Fong, C., Resnick, K., Wardle, J., Hanser, S., & Saper, R. (2017). Inpatient massage therapy versus music therapy versus usual care: a mixed-methods feasibility randomized controlled trial. Global Advances in Health and Medicine, 6, X17735816. PMid:29085740.

Rubens, F. D., Rothwell, D. M., Al Zayadi, A., Sundaresan, S., Ramsay, T., & Forster, A. (2018). Impact of patient characteristics on the Canadian Patient Experiences Survey-Inpatient Care: survey analysis from an academic tertiary care centre. BMJ Open, 8(8), e021575. PMid:30166297.

Sanyal, D. K., Bhowmick, P. K., & Das, P. P. (2021). A review of author name disambiguation techniques for the PubMed bibliographic database. Journal of Information Science, 47(2), 227-254.

Silva, B. B., Mergulhão, R. C., Favoretto, C., & Mendes, G. H. (2018). Critical success factors of Six Sigma implementations in companies in Brazil. International Journal of Lean Six Sigma, 10(2), 143-160.

Silva, J. H. O., Mendes, G. H. S., Cauchick Miguel, P. A., Amorim, M., & Teixeira, J. G. (2021). Customer experience research: intellectual structure and future research opportunities. Journal of Service Theory and Practice, 31(6), 893-931.

Sofaer, S., Crofton, C., Goldstein, E., Hoy, E., & Crabb, J. (2005). What do consumers want to know about the quality of care in hospitals? Health Services Research, 40(6p2), 2018-2036. PMid:16316436.

The Beryl Institute. (2020). Defining patient experience. Retrieved in 2020, January 15, from

Toomey, S. L., Zaslavsky, A. M., Elliott, M. N., Gallagher, P. M., Fowler, F. J., Jr., Klein, D. J., Shulman, S., Ratner, J., McGovern, C., LeBlanc, J. L., & Schuster, M. A. (2015). The development of a pediatric inpatient experience of care measure: child HCAHPS®. Pediatrics, 136(2), 360-369. PMid:26195542.

van den Hombergh, P., van Doorn-Klomberg, A., Campbell, S., Wensing, M., & Braspenning, J. (2016). Patient experiences with family medicine: a longitudinal study after the Dutch health care reforms in 2006. BMC Family Practice, 17(1), 118. PMid:27561993.

Verhoef, P. C., Franses, P. H., & Hoekstra, J. C. (2002). The effect of relational constructs on customer referrals and number of services purchased from a multiservice provider: does age of relationship matter? Journal of the Academy of Marketing Science, 30(3), 202-216.

Verhoef, P. C., Lemon, K. N., Parasuraman, A., Roggeveen, A., Tsiros, M., & Schlesinger, L. A. (2009). Customer experience creation: Determinants, dynamics and management strategies. Journal of Retailing, 85(1), 31-41.

Wallace, S., Hanson, K. T., Dowdy, S. C., & Habermann, E. B. (2018). Impact of surgical approach and patient factors on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scoring in gynecologic surgery. Gynecologic Oncology, 148(1), 28-35. PMid:29221835.

Wardhani, V., Utarini, A., van Dijk, J. P., Post, D., & Groothoff, J. W. (2009). Determinants of quality management systems implementation in hospitals. Health Policy, 89(3), 239-251. PMid:18752866.

Webster, C. S., Jowsey, T., Lu, L. M., Henning, M. A., Verstappen, A., Wearn, A., Reid, P. M., Merry, A. F., & Weller, J. M. (2019). Capturing the experience of the hospital-stay journey from admission to discharge using diaries completed by patients in their own words: a qualitative study. BMJ Open, 9(3), e027258. PMid:30862638.

Wiig, S., Storm, M., Aase, K., Gjestsen, M. T., Solheim, M., Harthug, S., Robert, G., & Fulop, N. (2013). Investigating the use of patient involvement and patient experience in quality improvement in Norway: rhetoric or reality? BMC Health Services Research, 13(1), 206. PMid:23742265.

Wilde, B., Starrin, B., Larsson, G., & Larsson, M. (1993). Quality of care from a patient perspective: a grounded theory study. Scandinavian Journal of Caring Sciences, 7(2), 113-120. PMid:8248668.

Wolf, C. P. X. P., & Jason, A. (2014). Defining patient experience. Patient Experience Journal, 1(1), 7-19.

Wolf, C. P. X. P., & Jason, A. (2019). The future of patient experience: Five thoughts on where we must go from here.Patient Experience Journal, 6(3), 1-4.

Wong, E. L., Coulter, A., Cheung, A. W., Yam, C. H., Yeoh, E. K., & Griffiths, S. (2013). Validation of inpatient experience questionnaire. International Journal for Quality in Health Care, 25(4), 443-451. PMid:23690442.

Wong, E. L., Coulter, A., Hewitson, P., Cheung, A. W., Yam, C. H., Lui, S. F., Tam, W. W., & Yeoh, E. K. (2015). Patient experience and satisfaction with inpatient service: development of short form survey instrument measuring the core aspect of inpatient experience. PLoS One, 10(4), e0122299. PMid:25860775.

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