Published: 15/07/2004, Volume II4, No. 5914 Page 20

Ben Page's analysis of the national patient survey results and other performance indicators is misleading (Ideas, pages 16-18, 1 July).

He has selected only one question - a global rating of satisfaction, the least informative component of the questionnaires designed by the Picker Institute for the national patient survey programme - and used this as a summary of patients' experience, thus distorting the purpose of the surveys.

The complexities of modern healthcare and the diversity of patients' expectations and experiences cannot be reliably evaluated by asking global rating questions such as: 'How satisfied were you with your care in hospital X?'

That is why we ask patients to report in detail on their experience of a particular provider at a specific point in time by answering whether or not certain processes or events occurred during the course of a defined episode of care.

Responses to this type of question are intended to be factual rather than evaluative.

They provide a reliable guide to specific aspects of patients' experience that need to be improved.

Knowing that, for example, 15 per cent of your patients rated their care as 'fair' or 'poor' does not give a manager or clinician a clear view of what they need to do to improve the quality of care.

However, if you know more precise details of what went wrong - for example, the proportion of patients who said they were not given information about possible side-effects of their medication - then working to improve the situation and monitoring trends in these indicators is much more productive.

The national patient surveys include measurements of patients' experience aimed at providing a stimulus for improvement. Benchmarking these against national norms and making comparisons with similar types of organisations can be useful.

Ranking trusts according to global satisfaction ratings, however, is not.

No matter where they are located, NHS staff should be working hard to improve the experience of all their patients instead of dismissing poor results as a function of geography or social composition.

Angela Coulter Chief executive Picker Institute Europe