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Patient feedback

The RACGP Patient feedback guide is a free companion document to the RACGP Standards for general practices (4th edition). This guide is an essential resource for meeting Criterion 2.1.2 Patient feedback.

Background

The new requirements for collecting patient feedback arose directly from feedback provided by members during extensive consultations on the development of the 4th edition Standards. Members argued that collecting patient feedback was of limited value to a practice unless the feedback was used to drive quality improvement activities. To support the tenets of person centred care and to ensure that practices would be using reliable data to initiate quality improvement plans, it was decided that in most situations practices would benefit from using a validated questionnaire to collect feedback on patients’ experiences of the practice.

RACGP approved patient feedback survey instruments

Criterion 2.1.2 Patient feedback requires practices at least once every 3 years to actively seek feedback about patients’ experiences of the practice ‘using a validated patient experience questionnaire that has been approved by the RACGP’

The RACGP has approved two validated patient feedback questionnaires for use in Australian general practices. The approval process involved a rigorous assessment of each survey tool by the RACGP Patient Feedback Advisory Committee (PFAC) which comprises GP academics, members of the RACGP National Standing Committee - Standards for General Practices, experts in social research and a consumer representative.

The two RACGP approved validated survey tools are:

Patient Accreditation Improvement Survey (PAIS) developed by Client-Focused Evaluations Program (CFEP). Two versions of the PAIS have been approved: one for whole of practice feedback, and one for practitioner specific feedback. For further information refer to: www.cfepsurveys.com.au/products/practice-accreditation/Default.aspx

And

PSI v4 of a Patient Satisfaction Instrument developed by Ultrafeedback. For further information refer to http://web.ultrafeedback.com/products/psi/

Practice specific method for collecting patient feedback

The Standards make allowance for special situations where a validated questionnaire may not be the best option for collecting patient feedback. Where a practice has a compelling reason for not using a validated patient experience questionnaire, the practice can develop a practice specific method of collecting patient experience feedback but needs to have the method approved by the RACGP before data collection commences to ensure the proposed method is suitably rigorous.

Patient Feedback Requirements Frequently Asked Questions

1. Why did the RACGP introduce new requirements for patient feedback in the RACGP Standards for general practices (4th edition)?
2. Why are the new data collection methods more rigorous?
3. Why do practices need to collect feedback on patients’ experiences of the practice rather than patients’ satisfaction with the practice?
4. What are the options for collecting patient experience feedback?
5. What is the best way to meet the new RACGP requirements on collecting patient experience feedback?
6. Can a practice add extra questions to a validated patient feedback questionnaire approved by the RACGP to meet particular needs?
7. Can a practice do a separate questionnaire, patient interviews or focus groups in addition to using a validated patient feedback questionnaire approved by the RACGP?
8. Are the validated patient feedback questionnaires approved by the RACGP suitable for practices where the majority of patients are of an Aboriginal or Torres Strait Islander background?
9. How should practices deal with the language translation of a validated questionnaire to suit their predominant patient population/s?
10. If a practice has a good reason for using a practice specific method to collect patient experience feedback, how should the practice go about it?
11. Can practices customise templates for patient feedback questionnaires, interview questions or focus group questions as the basis of a practice specific method for collecting patient feedback?
12. If a practice has a good reason for using a practice specific method to collect patient experience feedback, who can analyse the data?
13. How can the cost of the new requirements for collecting, analysing and using patient experience feedback be justified?
14. Does the RACGP have any financial interest directly or indirectly in the new patient feedback requirements?
15. Do services providing care outside normal opening hours have to seek and respond to feedback from patients?
16. Do services providing care outside normal opening hours and medical deputising services have to undertake structured patient experience feedback at least once every 3 years?
17. Who can develop a validated patient feedback questionnaire and apply to have it approved by the RACGP?
18. Why is full time equivalent (FTE) GP important and how is it calculated?
19. Where can I get more information about how to meet the new requirements for collecting, analysing and using patient experience feedback?

1. Why did the RACGP introduce new requirements for patient feedback in the RACGP Standards for general practices (4th edition)?
   The new requirements for collecting patient feedback arose directly from feedback provided by RACGP members during extensive consultations on the development of the 4th edition Standards. Members argued that collecting patient feedback was of limited value to a practice unless the feedback was used to drive quality improvement activities. Given the importance of patient feedback as a measure of safety and quality, a new mandatory measure was therefore introduced in the 4th edition Standards requiring practices to demonstrate quality improvements based on patient feedback.



2. Why are the new data collection methods more rigorous?
   To ensure practices are using reliable data to initiate meaningful quality improvement activities, the data collection methods required in the 4th edition Standards are more rigorous and evidence based.



3. Why do practices need to collect feedback on patients’ experiences of the practice rather than patients’ satisfaction with the practice?
   The scientific literature suggests patient experience is a more reliable measure of the health care services provided by a general practice than patient satisfaction. This means patient experience data is more likely to be a reliable measure of where a practice is doing well and where a practice needs to invest resources to improve. The primary purpose of collecting patient experience feedback is to generate practice specific data that can be used for quality improvement initiatives.



4. What are the options for collecting patient experience feedback?
   There are 2 options for collecting patient experience feedback.
   
   Option one: use a validated patient experience questionnaire that has been approved by the RACGP.
   Option two: develop a practice specific method of collecting patient experience feedback (questionnaire or focus groups or patient interviews).



5. What is the best way to meet the new RACGP requirements on collecting patient experience feedback?
   Using a validated patient feedback questionnaire approved by the RACGP is the recommended choice for most practices because it offers an expert, standardised, high quality and reliable way to collect and report feedback about patients’ experiences of a practice.



6. Can a practice add extra questions to a validated patient feedback questionnaire approved by the RACGP to meet particular needs?
   As a result of feedback from RACGP members, the independent companies which offer RACGP approved patient feedback questionnaires have agreed to develop and pre-test a pool of supplementary questions that can be added to an RACGP approved questionnaire without affecting its validity or reliability. Practices should discuss their needs with these companies to ensure supplementary practice specific questions will not compromise the validity or reliability of an RACGP approved questionnaire.



7. Can a practice do a separate questionnaire, patient interviews or focus groups in addition to using a validated patient feedback questionnaire approved by the RACGP?
   Yes. This is considered a good way to gain reliable data for quality improvement initiatives and address the particular circumstances of a practice.  RACGP approval is not required for a separate questionnaire, patient interviews or focus groups that supplement a validated, RACGP approved patient feedback questionnaire. However, where a practice plans to administer a separate questionnaire at the same time as a validated, RACGP approved patient feedback questionnaire, the practice should first check with the organisation supplying the validated questionnaire to ensure the concurrent administration of the separate questionnaire will not affect the validity and reliability of the validated instrument. 



8. Are the validated patient feedback questionnaires approved by the RACGP suitable for practices where the majority of patients are of an Aboriginal or Torres Strait Islander background?
   This is a decision individual practices/services will need to make for themselves. The RACGP understands that NACCHO and its Affiliates are exploring the feasibility of a validated patient feedback questionnaire expressly suitable for practices/services where the majority of patients are people of an Aboriginal or Torres Strait Islander background.



9. How should practices deal with the language translation of a validated questionnaire to suit their predominant patient population/s?
   To ensure the translation of a questionnaire does not affect its validity or reliability, practices should seek advice from the independent companies that offer the validated patient feedback questionnaires approved by the RACGP.



10. If a practice has a good reason for using a practice specific method to collect patient experience feedback, how should the practice go about it?
    The options for using a practice specific method to collect patient feedback are described in detail in the RACGP Patient Feedback Guide below.  In summary, the practice can develop and use questionnaires, focus groups or interviews. After the initial development, pre-testing and refinement (but prior to data collection), the practice needs to obtain RACGP approval to ensure the proposed method meets the requirements outlined in the Patient Feedback Guide.
    
    The RACGP notes that the development of practice specific methods can be time consuming and resource intensive for a practice since it is likely to require the purchase of external expertise. Practices are advised to assess the cost versus the benefits of collecting patient feedback in this way.



11. Can practices customise templates for patient feedback questionnaires, interview questions or focus group questions as the basis of a practice specific method for collecting patient feedback?
    In general it is recommended that most practices use a validated patient feedback questionnaire approved by the RACGP for collecting patient feedback.  Practices can also use a validated questionnaire plus separate questionnaires, focus groups or interviews to meet particular needs (see question 7).
    
    Where a practice has a compelling reason for using a practice specific method and uses templates developed by an external organisation such as a Division, GP Network or Medicare Local, the practice will need to customise the template to meet the specific needs of their practice and patient population and pre-test the customised templates. At this stage the practice then needs to seek RACGP approval for implementing its own method for collecting patient feedback prior to data collection and analysis (see also question 10).



12. If a practice has a good reason for using a practice specific method to collect patient experience feedback, who can analyse the data?
    The person who analyses the data from practice specific questionnaires, focus groups or interviews should have experience in data analysis and should not be a person who also provides clinical care to the patients involved.
    
    Where a practice will be using a suitably experienced external person (interviewer or facilitator) to conduct interviews or focus groups, this same independent person can analyse the data (assuming they do not provide clinical care to the patients involved).



13. How can the cost of the new requirements for collecting, analysing and using patient experience feedback be justified?
    Reliable patient feedback is a business investment for general practices because it indicates where a practice is doing well (and should do more of the same) and where a practice is not doing so well (and should initiate quality improvements to core activities such as patient safety, quality care, risk management, patient retention, staff performance etc). The cost of the new requirements can be thought of as an amortised annual expense associated with practice accreditation.



14. Does the RACGP have any financial interest directly or indirectly in the new patient feedback requirements?
    No, the RACGP does not have any financial interest directly or indirectly related to the new patient feedback requirements.



15. Do services providing care outside normal opening hours have to seek and respond to feedback from patients?
    Yes, services providing care outside normal opening hours need to seek and respond to feedback from patients. Services also need to seek and respond to feedback from practices for which they deputise.
    
    Where a patient provides feedback about their regular practice to a service providing care outside normal opening hours, the service should redirect this feedback to the patient’s regular practice.



16. Do services providing care outside normal opening hours and medical deputising services have to undertake structured patient experience feedback at least once every 3 years?
    Yes, services providing care outside normal opening hours and medical deputising services need to undertake structured patient experience feedback at least once every 3 years. Feedback may be sought from active and non-active patients of the service though it is likely to be more efficient for the service to seek structured feedback from patients at the time of a consultation. 



17. Who can develop a validated patient feedback questionnaire and apply to have it approved by the RACGP?
    Any individual or organisation with the relevant expertise and capacity to develop and scientifically validate a patient feedback questionnaire can apply to the RACGP to have the questionnaire approved for the purpose of enabling general practices to meet the requirements of Criterion 2.1.2 patient feedback in the RACGP Standards for general practices (4th edition). Application forms and further information is available from standards@racgp.org.au. An application fee applies.



18. Why is full time equivalent (FTE) GP important and how is it calculated?
    Full time equivalent general practitioner (GP) is important because it is the basis for calculating how many patient feedback questionnaires will be required for the practice to generate reliable data.  Where the practice has a fractional FTE the number of surveys required will generally be rounded up to improve the reliability of results (eg 3.5 FTE GPs will be rounded up to 4 FTE GPs for the purpose of calculating the number of surveys required).
    
    Full time equivalent GP is also important because it is the basis used by the independent companies offering validated patient feedback questionnaires for calculating their service costs to the practice. Where the practice has a fractional FTE, the cost will be calculated at the discretion of the companies offering the validated questionnaires but will generally be on a pro rata basis for fractional FTE.
    
    There are different ways to ‘count’ full time equivalence.  For patient feedback purposes, it is assumed general practices and each of the companies offering validated patient feedback questionnaires will adopt a common sense approach.
    
    As a basic guide for calculating the number of patient feedback surveys a practice must undertake and service costs to the practice, a full time equivalent GP may be considered as a GP who works 37 hours per week in typical general practice activities.



19. Where can I get more information about how to meet the new requirements for collecting, analysing and using patient experience feedback?
    The RACGP Patient Feedback Guide (below) summarises the requirements for collecting and analysing patient experience feedback using a validated questionnaire approved by the RACGP or using practice specific methods approved by the RACGP.

Further information

Organisations seeking to have a scientifically validated questionnaire approved by the RACGP or individual practices seeking to have a practice specific method approved by the RACGP are invited to obtain further information and application forms by contacting standards@racgp.org.au. Application fees apply.

General practices requiring information about patient feedback processes are encouraged to read the Patient Feedback Guide thoroughly. Questions may be addressed to standards@racgp.org.au.

Last Modified: 9 March 2012
Authorised By: Standards