title: Instruments to measure patient experience of health care quality in hospitals: a systematic review protocol.
abstract: BACKGROUND
  Improving and sustaining the quality of care in hospitals is an intractable and persistent challenge. The patients' experience of the quality of hospital care can provide insightful feedback to enable clinical teams to direct quality improvement efforts in areas where they are most needed. Yet, patient experience is often marginalised in favour of aspects of care that are easier to quantify (for example, waiting time). Attempts to measure patient experience have been hindered by a proliferation of instruments using various outcome measures with varying degrees of psychometric development and testing.
  
  
  METHODS
  We will conduct a systematic review and utility critique of instruments used to measure patient experience of health care quality in hospitals. The databases Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (Psych Info) and Web of Knowledge will be searched from inception until end November 2013. Search strategies will include the key words; patient, adult, hospital, secondary care, questionnaires, instruments, health care surveys, experience, satisfaction and patient opinion in various combinations. We will contact experts in the field of measuring patient experience and scrutinise all secondary references. A reviewer will apply an inclusion criteria scale to all titles and abstracts. A second reviewer will apply the inclusion criteria scale to a random 10% selection. Two reviewers will independently evaluate the methodological rigour of the testing of the instruments using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Disagreements will be resolved through consensus. Instruments will be critiqued and grouped using van der Vleuten's utility index. We will present a narrative synthesis on the utility of all instruments and make recommendations for instrument selection in practice.
  
  
  CONCLUSIONS
  This systematic review of the utility of instruments to measure patient experience of hospital quality care will aid clinicians, managers and policy makers to select an instrument fit for purpose. Importantly, appropriate instrument selection will provide a mechanism for patients' voices to be heard on the quality of care they receive in hospitals. PROSPERO registration CRD42013006754.
authors.affiliation: School of Nursing, Midwifery and Health, University of Stirling, Highland Campus, Centre for Health Science, Old Perth Rd, Inverness IV2 3JH, UK. michelle.beattie@stir.ac.uk.
authors.forename: Michelle
authors.initials: M
authors.lastname: Beattie
authors.forename: William
authors.initials: W
authors.lastname: Lauder
authors.forename: Iain
authors.initials: I
authors.lastname: Atherton
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Murphy
mesh_terms: D019538:Health Care Surveys / Q000592:standards; D006761:Hospitals / Q000592:standards*; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011594:Psychometrics; D011787:Quality of Health Care / Q000592:standards*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards; D000078202:Systematic Reviews as Topic