BMJ Qual Saf 21:600-605 doi:10.1136/bmjqs-2012-000906
  • Original research

Associations between internet-based patient ratings and conventional surveys of patient experience in the English NHS: an observational study

Editor's ChoicePress Release
  1. Christopher Millett1
  1. 1Department of Primary Care and Public Health, Imperial College London, London, UK
  2. 2Department of Surgery and Cancer, Imperial College London, UK
  3. 3Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Felix Greaves, Department of Primary Care and Public Health, Reynolds Building, Charing Cross Campus, Imperial College London, London W6 8RP, UK; felix.greaves08{at}
  1. Contributors All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. Study design: FG and CM. Acquisition of data: FG. Analysis and interpretation of data: FG, UJP, DK, AD, AM, RMW and CM. Drafting of manuscript: FG and CM. Statistical analysis: UJP and FG. Critical revision of the manuscript for important intellectual content: UJP, AD, CM and RMW. Study supervision: CM, AM, AD and RMW.

  • Accepted 31 March 2012
  • Published Online First 20 April 2012


Objective Unsolicited web-based comments by patients regarding their healthcare are increasing, but controversial. The relationship between such online patient reports and conventional measures of patient experience (obtained via survey) is not known. The authors examined hospital level associations between web-based patient ratings on the National Health Service (NHS) Choices website, introduced in England during 2008, and paper-based survey measures of patient experience. The authors also aimed to compare these two methods of measuring patient experience.

Design The authors performed a cross-sectional observational study of all (n=146) acute general NHS hospital trusts in England using data from 9997 patient web-based ratings posted on the NHS Choices website during 2009/2010. Hospital trust level indicators of patient experience from a paper-based survey (five measures) were compared with web-based patient ratings using Spearman's rank correlation coefficient. The authors compared the strength of associations among clinical outcomes, patient experience survey results and NHS Choices ratings.

Results Web-based ratings of patient experience were associated with ratings derived from a national paper-based patient survey (Spearman ρ=0.31–0.49, p<0.001 for all). Associations with clinical outcomes were at least as strong for online ratings as for traditional survey measures of patient experience.

Conclusions Unsolicited web-based patient ratings of their care, though potentially prone to many biases, are correlated with survey measures of patient experience. They may be useful tools for patients when choosing healthcare providers and for clinicians to improve the quality of their services.


  • Role of Sponsors Study sponsors had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

  • Some contents of this manuscript have been accepted to be presented at the BMJ International Forum on Quality and Safety in Healthcare in Paris, 20 April 2012.

  • Funding There was no specific funding for this project. CM is funded by the Higher Education Funding Council for England and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care scheme (CLAHRC) for North West London. Imperial College London is grateful for support from the National Institute for Health Research Biomedical Research Centre Funding scheme, the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care scheme, and the Imperial Centre for Patient Safety and Service Quality. Dr Wachter conducted much of this work while at Imperial College London in 2011 under a US-UK Fulbright scholarship. The funding sources had no role in the design and conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review or approval of the manuscript.

  • Competing interests Dr Wachter reports having an equity interest and/or serving on paid advisory boards for PatientSafe Solutions and CRISI; receiving support for helping to lead a leadership training program for IPC-The Hospitalist Company; receiving honoraria from the American Board of Internal Medicine for serving on its board of directors and Executive Committee; receiving honoraria for many speeches on patient safety and quality; receiving support from John Wiley and Sons for writing a blog; and receiving funding under a contract from the Agency for Healthcare Research and Quality for editing two patient-safety websites and royalties from publishers from two books on patient safety. Dr Wachter is a 2011 recipient of a US-UK Fulbright Award for study in the UK. Professor Darzi was Parliamentary Under-Secretary of State (Lords) in the United Kingdom Department of Health from 2007 to 2009. Professor Majeed has received funding for research from Dr Foster Intelligence, a commercial health intelligence company. The other authors declare no support from any organisation for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available on request from the corresponding author.

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