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Research overview

National and cross-national surveys of patient experiences: a structured review

Measurement of patient experiences is an important component in the evaluation of health services. The purpose of this report has been to identify and summarise such national and cross-national surveys.

  • Issued/Revised: 2008
  • Garratt AM, Solheim E, Danielsen K. National and cross-national surveys of patient experiences: a structured review. Research overview 2008. ISBN (digital): 978-82-8121-197-1, ISSN (digital): 1890-1298. Available at www.fhi.no/en



Key message

There have been a large number of national and cross-national surveys of patient experiences, the majority of which are part of ongoing programs of work. It is recommended that those undertaking measurement of patient experiences draw upon this large volume of work as a means of informing future surveys and give consideration to:

1. Organisation and infrastructure including the potential for collaboration

2. Survey methodology

3. Questionnaires with evidence for data quality, reliability and validity including evidence for cross-cultural equivalence

4. Methods of reporting and dissemination of results to interested groups

The review’s main implications for the Organisation for Economic Co-operation and Development and its Health Care Quality Indicators Project relating to the cross-national measurement of patient experiences are to give consideration to:

1. Collaboration with individuals and groups that have been active in national and cross-national surveys and particularly infrastructure and programs of work

2. Survey methodology that can be implemented in a consistent way cross-nationally

3. Questionnaires that have evidence for data quality, reliability, and cross-cultural equivalence

4. Reporting of results including case-mix adjustment and presentation that recognises the needs of interested groups



The measurement of patient experiences is an important component of health ser-vices evaluation. Several countries now have programs of work that include national surveys of patients undertaken at regular intervals. The identification and review of large scale surveys of patient experiences including programs of work, will inform the organisation and design of future surveys aimed at comparing patient views of health care quality across countries.


To identify and review national and cross-national surveys, including programs of work relating to patient experiences and satisfaction.


Structured review of national and cross-national surveys of patient experiences or satisfaction for OECD and non-OECD European Union member countries undertaken from 1997 onwards for which results were available at the end of April 2007. All patient groups and general population surveys were included. Searches of electronic databases and the web were undertaken and a link to an electronic questionnaire was sent to contact persons identified by the OECD. Published articles relating to national and cross-national surveys of patient experiences or satisfaction with health care were retrieved from the following databases: CINAHL, EMBASE, MED-LINE(R) and PsycINFO using search terms derived from previous systematic re-views relating to patient experiences. Online searches were used to identify websites relating to organizations involved in the measurement of patient experiences. These websites were searched for relevant information including survey reports. Data were extracted relating to the background to the survey, survey design, reporting of results, important references and website links. Members of the OECD Health Care Quality Indicators Project group were asked to name contact persons with knowledge of survey work within countries that were not covered in the main review. The contact persons were sent an email with a link to an electronic questionnaire that asked for information relating to survey work.


The searches of the electronic databases produced 2506 references from which 166 were obtained on the basis of the contents of the title or abstract. 55 surveys met the inclusion criteria, 42 of which were national and 13 were cross-national. Nine ongoing programs of work had undertaken 39 of these surveys: the Canadian Community Health Survey (CCHS), The Commonwealth Fund (USA), Consumer Assessment of Healthcare Providers and Systems (USA), Department of Quality Measurement (Denmark), Dutch Centre for Consumer Experience in Health Care, Norwegian Knowledge Centre for the Health Services, Picker Institute Europe, Unit of Patient Evaluation (Denmark), and the World Health Organisation (WHO) program The Health Systems Responsiveness. The Commonwealth Fund, Picker Institute Europe and WHO have undertaken cross-national comparisons of patient experiences. The CCHS, The Commonwealth Fund and WHO programs are all surveys of the general population. The remainder relate to patients who have received care and for the CAHPS and one of the surveys undertaken by the Dutch Centre, health plan members and health insurance enrolees respectively.

Six cross-national surveys were not part of ongoing programs of work: the Diabetes Attitudes Wishes and Needs (DAWN) study, the European Research into the Treatment of Cancer (EORTC) study, the European Psychiatric Services Inputs Linked to Outcome Domains and Needs (EPSILON) study, the European Task Force on Patient Evaluations of General Practice (EUROPEP), primary care in 12 countries, and spinal cord injury in three countries. Ten national surveys were not ongoing national programs and included acute care hospitals (Ireland), antenatal care (Sweden), breast health practices (Canada), Centers’ for Womens’s Health (USA), HIV infection (USA), cystic fibrosis (UK), depression among African-American women (USA), maternity care (England, Scotland), and osteopathy (USA).

The link to the electronic questionnaire was emailed to nine contact persons and eight responded. In addition to the work above, respondents provided information relating to ongoing surveys or programs of work for Iceland, Japan, New Zealand and Turkey. Japan and New Zealand have also been part of cross-national surveys.

This is a publication from the Norwegian Knowledge Centre for the Health Services. The Knowledge Centre became part of the Norwegian Institute of Public Health 01/01/2016.