Open Access Open Badges Research article

It takes patience and persistence to get negative feedback about patients’ experiences: a secondary analysis of national inpatient survey data

David N Barron1, Elizabeth West2*, Rachel Reeves3 and Denise Hawkes4

Author Affiliations

1 Saïd Business School and Jesus College, University of Oxford, Park End Street, Oxford OX1 7HP, UK

2 Mary Seacole Building, School of Health and Social Care, University of Greenwich, Avery Hill Road, Eltham, London SE9 2UG, UK

3 School of Health and Social Care, University of Greenwich, Avery Hill Road, Eltham, London, UK

4 Doctoral School at the Institute of Education, University of London, London, UK

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BMC Health Services Research 2014, 14:153  doi:10.1186/1472-6963-14-153

Published: 4 April 2014



Patient experience surveys are increasingly used to gain information about the quality of healthcare. This paper investigates whether patients who respond before and after reminders to a large national survey of inpatient experience differ in systematic ways in how they evaluate the care they received.


The English national inpatient survey of 2009 obtained data from just under 70,000 patients. We used ordinal logistic regression to analyse their evaluations of the quality of their care in relation to whether or not they had received a reminder before they responded.


33% of patients responded after the first questionnaire, a further 9% after the first reminder, and a further 10% after the second reminder. Evaluations were less positive among people who responded only after a reminder and lower still among those who needed a second reminder.


Quality improvement efforts depend on having accurate data and negative evaluations of care received in healthcare settings are particularly valuable. This study shows that there is a relationship between the time taken to respond and patients’ evaluations of the care they received, with early responders being more likely to give positive evaluations. This suggests that bias towards positive evaluations could be introduced if the time allowed for patients to respond is truncated or if reminders are omitted.

Patient satisfaction/statistics and numerical data; Hospitals/standards; Health care surveys/methods; Bias (epidemiology); Questionnaires