It takes patience and persistence to get negative feedback from patients

Background: Patient experience surveys are increasingly used to gain information about the quality of healthcare. This paper investigates whether patients who respond early or late, and before and after reminders, to a large national survey of in-patient experience differ in systematic ways in how they evaluate the care they received. Methods: The English national in-patient survey of 2009 obtained data from just under 70,000 patients. We analyse their responses to the question “Overall, how did you rate the care you received” in relation to the time they took to respond and whether or not they had had a reminder, using statistical models designed to examine the length of time taken for an event to occur, known as “failure time regression models”. Results: 41 per cent of patients responded after the first questionnaire and 11 per cent after reminders. Those who were least positive in their evaluation of care replied on average 3.1 days later than the most positive. However, the main dividing line was between patients who responded to the initial mailing or to the reminders. Even controlling for other factors that influence the likelihood of an early response, those who respond after the initial mailing were more likely to be positive about the care they received. Conclusion: This study, using a large national dataset, shows that bias towards a positive evaluation of care could be introduced if the length of time that patients are allowed to respond is truncated or if reminders are omitted. Both patience (time) and persistence (reminders) are required to achieve unbiased results. Quality improvement efforts depend on having accurate data and negative evaluations are particularly valuable. The relevance of these findings for recent developments in patient evaluation and quality improvement are drawn out, as well as the implications for practitioners, managers and policy makers