The Picker Survey

Researchers at the Picker Institute had suspected, and later confirmed through extensive research, that simply adopting the accepted measurement tools in place then, and even today, would not in fact assist hospitals in improving patient experience and outcome. They theorized that current patient experience tools and programs too often approached the task from an institutional mindset and failed to collect data most relevant to patients.

Thus, the Picker Institute pioneered the use of carefully designed instruments to obtain detailed reports of patient's experience. Instead of asking patients to provide simple satisfaction ratings, as had been standard practice for measuring care, the Picker surveys asked patients whether or not certain processes and events occurred during the course of a specific episode of care. Following extensive research to find out what patients thought about the way they were treated and what the problems were from their point of view, questionnaires were designed to focus on specific dimensions of patients' experience. These questionnaires have been used since 1987 in hospitals in the US and Canada, since 1994 in the UK, and since 1997 in Germany, Sweden and Switzerland.

The Picker inpatient surveys distinguish eight dimensions of patient-centered care:

Access (including time spent waiting for admission or time between admission and allocation to a bed in a ward);
Respect for patient's values, preferences, and expressed needs (including impact of illness and treatment on quality of life, involvement in decision making, dignity, needs and autonomy);
Coordination and integration of care (including clinical care, ancillary and support services, and "front-line" care);
Information, communication, and education (including clinical status, progress and prognosis, facilitation of autonomy, self-care and health promotion);
Physical comfort (including pain management, help with activities of daily living, surroundings and hospital environment);
Emotional support and alleviation of fear and anxiety (including treatment and prognosis, impact of illness on self and family, financial impact of illness);
Involvement of family and friends (including social and emotional support, involvement in decision making, impact on family dynamics and functioning);
Transition and continuity (including information about medication and danger signs to look out for after leaving the hospital, coordination and discharge planning, clinical, social, physical and financial support).

The questionnaire is designed to be analyzed by creating 40 dichotomous "problem scores" indicating the presence or absence of a problem. These can be summed into "dimension scores" representing the groupings listed above. In addition, some "rating" questions are included to assess patients' overall experience.

Picker Surveys are internationally available. For additional survey information in the UK and Europe, exclusive of Switzerland and Germany, click here. For additional survey information in Germany, click here. For additional survey information in Switzerland please click here. For additional survey information in other parts of the world, please contact National Research Corporation.

What is the “Picker” approach?

The Picker Institute began when Harvey and Jean Picker experienced the healthcare system first-hand. Despite their resources and influence - the Picker family refined and marketed early and subsequent x-ray machines, and Jean was for many years, a U.S. Ambassador to the United Nations - they realized the healthcare system did not meet patients' needs.

Dr. Harvey Picker emerged from the ordeal with a clear goal and conscious commitment, to improving healthcare delivery and creating a patient-centered care environment, which meets the true needs and concerns of patients and their family members. Dr. Picker joined with researchers at the Harvard Medical School and set about uncovering issues that matter most to patients and their families, and that would assist hospital staff in improving the delivery of care in areas that matter most to patients.

From that commitment, and with assistance from the Commonwealth Fund and Beth Israel Hospital, grew the Picker Institute, a not-for-profit entity dedicated solely to developing a patient-centered research approach to performance measurement.

While the Picker Institute provides patient experience measurement services to the healthcare industry, its history and mission are deeply rooted in the pure research arena. Researchers at the Institute suspected, and later confirmed through extensive research, that simply adopting the accepted measurement tools in place then, and even today, would not in fact assist hospitals in improving patient experience and outcome. They theorized that current patient satisfaction tools and programs too often approached the task from an institutional mindset and quite literally failed to collect data most relevant to patients. Throughout those next seven years, extensive interviews with more than 8,000 patients, family members, physicians, and hospital staff were conducted. Researchers sought to uncover the answer to four basic questions. They were:

What do patients want?

What do patients value?

What helps or hinders their ability to manage their health problems?

What aspects of care are most important to them and their families?

Results of the interviews were used to identify the areas of care most important to patients and their family members. At the same time, the Picker Institute developed a unique approach - they asked patients and family members to objectively report on their experience with the care provided, rather than provide simple satisfaction ratings. Doing so provides hospitals and staff with clear areas of focus.

What researchers at the Picker Institute developed, has become the world standard for measuring performance through the patient's eyes. The Picker family of patient experience surveys is being used in quality-driven organizations throughout the U.S., Canada, Great Britain, Germany, and Sweden largely because they apply the patient perspective to performance measurement.

The following sections describe the two major discoveries of the Institute.

Why you should use the Picker Survey?

Simply put – because it is recognized as the “gold standard” in Patient Care survey instruments and methodologies.

A 15-year research project, in collaboration with researchers at Harvard Medical School, resulted in the development of the Picker family of patient-centered care survey instruments in 1987.

The Picker Approach outlines eight dimensions of patient-centered care as the key drivers of quality. They include: respect for patient's values, preferences and expressed needs, coordination and integration of care, information, communication and education, physical comfort, emotional support, involvement of family and friends, transition and continuity, and access to care.

The most widely used Patient Care survey instruments and methodologies in the US, Canada and Europe

Now, the Picker Patient Center-care survey can be easily accessed by your organization, through several of the Picker Institute affiliates.

Info on our international offices >

For more information on Picker surveys in the US and Canada >