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Patient Experience, Guide5 reasons to replace satisfaction surveys with PREMs in your hospital
Most hospitals measure their quality with satisfaction surveys because, until now, no complete set of PREMs validated by hospital service existed in Spanish. The Vall d'Hebron, IEXP and RateNow study changes that.
Almost every hospital evaluates patient experience with satisfaction surveys: internal, non-validated questionnaires that ask how "satisfied" the patient was. They are used because, until now, no scientifically validated set of questionnaires existed for the generic services of a hospital (inpatient care, outpatient clinics, emergency care, ambulatory surgery) in Spanish. The study by Vall d'Hebron, IEXP and RateNow — published in the Journal of Patient Experience — fills that gap with 5 PREM (Patient Reported Experience Measures) questionnaires validated by service. Here are the reasons why a PREM is not an "improved" version of a satisfaction survey, but a fundamentally different way of measuring — and where you can download them for free.
Diana Bardales, 2026 
9 min 
If you ask a hospital manager how they measure their patients' experience, the answer is very likely to be: with a satisfaction survey. It is the default tool in the vast majority of centres, for a very specific reason: until this study was published, there was no organic set of scientifically validated PREM questionnaires covering the main services of a hospital — regardless of the patient's condition.
Validated PREMs did exist for specific pathologies or integrated practice units, and even for inpatient care, but the same scientific backing was missing for other key services such as outpatient clinics, emergency care or ambulatory surgery. Faced with that gap, the reasonable alternative has always been an in-house satisfaction survey: quick to put together, but limited in what it can actually tell you.
The Vall d'Hebron, IEXP and RateNow study closes that gap with 5 PREM questionnaires validated by service. And understanding why that matters requires first understanding the fundamental difference between a PREM and a satisfaction survey.
The qualitative leap: from satisfaction to experience
A satisfaction survey essentially asks how happy the patient was: "how would you rate the care received?", "were you satisfied with the treatment?". These are opinion questions, and opinions depend on each person's expectations: a demanding patient and an easy-going one can live through exactly the same visit and score it very differently. This makes "satisfaction" difficult to compare across patients, and nearly impossible to translate into a concrete action for the hospital.
A PREM asks something different: not how the patient felt in general terms, but what happened to them during the care process. During the validation of these questionnaires, researchers deliberately avoided words like "rate", "sufficient" or "satisfactory", replacing them with questions about verifiable facts: whether they were informed before discharge, whether their pain was managed, whether they could find their way around the centre. That shift from "how would you rate...?" to "were you informed before discharge?" is not a nuance of wording: it is the qualitative leap that separates a satisfaction survey from a PREM. It moves from a subjective score, shaped by each patient's expectations, to a concrete fact that a team can correct.
Furthermore, each item in a PREM is chosen because it meets two conditions simultaneously: the patient can evaluate it and the hospital management team can change it. Satisfaction surveys, by contrast, tend to mix aspects the hospital controls (staff behaviour, information provided) with others it does not (the building, waiting lists, the patient's own health status), which dilutes the usefulness of results when deciding what to do.
The question shift
Replacing an opinion question ("how would you rate...?") with a factual question ("were you informed before discharge?") is not just a nuance of wording: it changes what you can do with the data.
You move from a subjective score to a concrete action that a team can correct.
Reason 1: you measure experience (facts), not satisfaction (perception)
This is the fundamental reason, from which all the others follow. A satisfaction survey tells you whether the patient was happy; a PREM tells you what happened. The difference is that between a thermometer and a diagnosis: the first gives you a temperature, the second tells you where the problem is and which lever to move to solve it.
Reason 2: results are comparable across services, hospitals and over time
Satisfaction surveys tend to be designed behind closed doors, service by service, hospital by hospital, and change with every revision: as soon as someone rephrases a question, comparison with historical data becomes unreliable, and comparing results with another centre is simply impossible because no one else uses exactly the same questions. Being a standardised set validated by service, the PREMs from this study made it possible to calculate a benchmark average NPS for each type of service and detect real differences of up to 60 points between, for example, paediatrics and telemedicine visits. That comparability — across units, across centres and over the years — is structurally unavailable to a bespoke satisfaction survey.
Reason 3: each question is actionable, not merely descriptive
Since each item was designed so that the patient can evaluate it and the hospital can change it, the results can be fed directly into management dashboards accessible to professionals at the centre — something rarely seen with traditional satisfaction surveys. An average "satisfaction" score of 7.8 out of 10 does not tell a department head what to change tomorrow; knowing that 30% of patients were not informed before discharge does.
Reason 4: it has peer-reviewed scientific backing
An in-house satisfaction survey, however well-intentioned, goes through no external review: a team designs it, it is launched, and no one outside the hospital verifies that it actually measures what it claims to. A validated and published PREM does: it goes through cognitive testing with real patients, factor analysis and statistical reliability calculation, and is subject to peer review before publication. The five questionnaires in this study required more than a year of psychometric and cognitive validation work, with between 106 and 1,353 patients per questionnaire and wave, across 11 hospitals in 4 Spanish autonomous communities.
106 – 1,353
Patients required per questionnaire and validation wave, across 11 hospitals, over more than a year of work.
Source: Gimenez et al., Journal of Patient Experience, 2026
Reason 5: they already exist, are free, and fill the gap that forced you to use a satisfaction survey
Until now, the main reason for continuing to use a satisfaction survey was not that it was better, but that there was no validated alternative for the generic services of a hospital. That gap is now filled: 5 validated PREM questionnaires, ready to use, organised by service — Inpatient Care, Outpatient Clinics (adults and paediatrics), Emergency Care without admission and Major Ambulatory Surgery — available in Spanish, Catalan and English. Between them they accumulate more than 235,000 patient responses at the pilot hospital alone, before even going through multicentre validation at the other 10 centres. They are free to use, though protected by copyright of the consortium formed by Vall d'Hebron, IEXP and RateNow, so authorisation must be requested before implementing them.
""They are comprehensive, cross-cutting instruments that are already being used in the hospitals that have joined. We encourage interested parties to contact us, because they are free to use... and because the more adoption they get, the more value they generate for the whole sector," says Albert Esplugas, CEO of RateNow.
| Dimension | Satisfaction survey | PREM validated by service |
|---|---|---|
| What it measures | General perception/opinion, shaped by expectations | Concrete facts of the care process |
| Question design | Based on intuition or internal template | Based on literature, focus groups and factor analysis |
| Objectivity | Mixes opinion and facts, including aspects outside hospital control | Only verifiable facts, actionable by the team |
| Comparability | Limited, changes with each revision and across centres | Stable across services, hospitals and years |
| Backing | None | Peer-reviewed, published |
| Availability | Already available, but measures little | Free, but requires consortium authorisation |
Continuing to measure with a satisfaction survey is not a mistake on your team's part: for years it was the only reasonable option in the face of a real gap. But that gap no longer exists for the most common services of a hospital, and the cost of sticking with the old model shows up later: data that cannot be compared, questions that measure satisfaction instead of experience, and no backing if someone asks where the numbers come from.
Bibliography
- Gimenez, E., Aguayo, M., Muñoz, L., et al. "Multicentric Design and Validation of a Set of Democratized Hospital Patient Reported Experience Measures in Spain." Journal of Patient Experience, 2026. DOI: 10.1177/23743735261458055.
What is the difference between a PREM and a satisfaction survey? 
A satisfaction survey asks for the patient's general opinion ("how would you rate the care?"), something that depends on each person's expectations. A PREM asks about concrete, verifiable facts of the care process ("were you informed before discharge?", "was your pain managed?"), making it more objective, comparable and actionable for the management team.
How much does it cost and how long does it take to validate a PREM questionnaire?
In the reference study, the cognitive and psychometric validation of 5 questionnaires took more than a year, with samples of between 106 and 1,353 patients per questionnaire and wave across 11 hospitals. It is a process that few organisations can undertake on their own, which explains why most still resort to in-house satisfaction surveys.
Can I use the PREMs validated by Vall d'Hebron, IEXP and RateNow directly?
Yes, they are free to use and available in Spanish, Catalan and English, but are protected by copyright of the consortium. Before implementing them at your centre, send us a message through our form indicating "Obtain validated PREMs", and we will help you manage the authorisation for your service and use case.
Where can I download the PREMs validated by hospital service?
You can request them through our form, indicating "Obtain validated PREMs" along with the service and use case for which you want to apply them; the team manages the authorisation from the consortium formed by Vall d'Hebron, IEXP and RateNow.
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