A mixed-methods analysis of patient reviews of hospital care in England: implications for public reporting of health care quality data in the United States

Jt Comm J Qual Patient Saf. 2013 Jan;39(1):7-15. doi: 10.1016/s1553-7250(13)39003-5.


Background: In the United States patients have limited opportunities to read and write narrative reviews about hospitals. In contrast, the National Health Service (NHS) in England encourages patients to provide feedback to hospitals on their quality-reporting website, NHS Choices. The scope and content of the narrative feedback was studied.

Methods: All NHS hospitals with more than 10 reviews posted on NHS Choices were included in a cross-sectional mixed-methods (qualitative and quantitative) analysis of patients' reviews of 20 randomly selected hospitals.

Results: The final sample consisted of 264 hospitals and 2,640 patient responses to structured questions. All 200 reviews from the 20 hospitals randomly selected were subjected to further quantitative and qualitative analysis. Comments about clinicians and staff were common (179 [90%]) and overwhelmingly positive, with 149 (83%) favorable to workers. In 124 (62%) of the 200 reviews, patients commented on technical aspects of hospital care, including quality of care, injuries, errors, and incorrect medical record or discharge documentation. Perceived medical errors were described in 51 (26%) hospital reviews. Comments about the hospital facility appeared in half (52%) of reviews, describing hospital cleanliness, food, parking, and amenities. Hospitals replied to 56% of the patient reviews.

Discussion: NHS Choices represents the first government-run initiative that enables any patient to provide narrative feedback about hospital care. Reviews appear to have similar domains to those covered in existing satisfaction surveys but also include detailed feedback that would be unlikely to be revealed by such surveys. Online narrative reviews can therefore provide useful and complementary information to consumers (patients) and hospitals, particularly when combined with systematically collected patient experience data.

MeSH terms

  • Attitude of Health Personnel
  • Communication
  • Cross-Sectional Studies
  • England
  • Hospital Bed Capacity
  • Hospitals / standards*
  • Humans
  • Patient Care / standards*
  • Patient Care Team
  • Patient Participation
  • Patient Satisfaction
  • Patients*
  • Quality Indicators, Health Care
  • Quality of Health Care / standards*
  • State Medicine
  • United States
  • Waiting Lists