Step 2.4 – Decide whether you need to adapt AHPEQS

Outcome: By completing Step 2.4, you will have decided whether and why you would like to adapt some aspect of AHPEQS, and you will understand the implications of doing this. 

Things to consider

This page lists the items that need to be considered in Step 2.4 to  decide whether you need to adapt some aspects of AHPEQS.

Reasons for adapting AHPEQS

You may wish to adapt AHPEQS to better suit your own circumstances. Reasons for adapting AHPEQS may include:

  • Using AHPEQS in different types of services to those in which the Commission tested them
  • Using AHPEQS in different types of patients to those with whom the Commission tested them
  • Ensuring the concepts addressed in the questions are culturally appropriate for diverse populations
  • Keeping some questions from an existing survey to preserve time series data or to reflect organisational priorities
  • Adding supplementary questions around AHPEQS to target issues of local relevance or to get more detail (for example, qualitative content) or context.

Reliability and validity of AHPEQS

AHPEQS cannot be considered valid or reliable unless you use the questions in one of the ways they were originally tested. If you want to establish reliability and validity for other modes of administration, ‘nesting’ the questions within other surveys, adapting any question, reordering or interspersing questions, or use with other patient populations or service settings, you will need to do your own field testing and statistical analysis.

Bear in mind that if you adapt AHPEQS in any way you still need to adhere to the licence conditions, which include attributing the original questions to the Commission and noting how you have adapted them.

Types of adaptation

Examples of ways you might consider adapting AHPEQS include:

  • Including an AHPEQS module in a bigger survey
    You may wish to ‘nest’ AHPEQS as a module within a larger set of patient experience questions. If you are doing this, it is preferable to keep the AHPEQS questions together in the same order, retain the rating scales for each question, and use all of the questions. Some early implementers have added net promoter scores, an opportunity for free text comment, and questions which are particularly relevant for their organisational priorities or to continue a time series from an old survey.
  • Using AHPEQS plus local options
    Within a group of hospitals or services, the same core set of questions (AHPEQS) can be asked across the whole group, with freedom for each hospital or service to add in additional questions that suit their particular local circumstances, quality improvement initiatives or strategic objectives. 
  • Adapting wording or content
    Adapting the AHPEQS wording or response options is generally not recommended unless you are going to do a field test and statistical analysis of the new wording for a different patient population. For example, some sites are testing the acceptability and relevance of AHPEQS for outpatients, mental health patients, parents of children and neonates, and other populations which were not part of the Commission’s original field testing.

Any of the above may be temporary adjustments to meet particular organisational priorities or support quality improvement initiatives.

Free text questions

Early implementers of AHPEQS have all found that incorporating an opportunity for the patient to give a free text comment is valuable. This is usually in the form of a general question about what made the respondent rate their overall experience in the way they did. Advantages of adding such an opportunity are that:

  • The reasons behind a person’s multiple choice AHPEQS responses become easier to interpret and act on
  • Common themes from free text responses can help early detection of emerging patterns of good or poor practice, can be used in training, and can be used to feed compliments back to particular staff 
  • Any remedial action required by the health service can be done on a case-by-case basis in a timely way (if the person discloses an incident, near miss or other concern about safety and quality)
  • Free text responses are valuable ‘safety valves’ for patients who feel that the AHPEQS questions did not ‘get at’ their main issues or feedback.

Commission consumer research

If you decide to supplement AHPEQS with questions to measure other concepts or to get more detail about a particular aspect of experience, you are welcome to make use of the findings from original research by the Commission into factors that influence patients’ experiences. 

In this research, consumers were asked to tell a personal story of a recent experience of health care and to nominate the aspects of that experience which made it good, poor or ‘average’ overall. From rigorous analysis of 16 focus group discussions, 101 factors emerged. Together, these factors comprehensively reflect what is important to Australian healthcare consumers. This framework is available on request from the Commission, and will be available on this website soon.

This was the first stage in development of AHPEQS, and the factors fit into a framework which covers 20 dimensions of experience. It was impossible for us to incorporate all dimensions into a short generic question set, but you may wish to make use of this framework to suit your own circumstances.

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