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Patient Experience, GuideGuide: How to move from satisfaction surveys to PREMs in your hospital
You need to choose carefully what to measure, start from already validated tools and send them to the right patient at the right moment.
Measuring PREMs in a hospital comes down to five steps: choosing the areas you want to measure, finding questionnaires already validated in your language, requesting authorisation from their authors, testing them with a small group of patients and automating the send so that each patient receives it right after their visit. If you currently use satisfaction surveys, now is the time to make the leap. And you no longer need to start from scratch: Vall d'Hebron, IEXP and RateNow have published five PREM questionnaires in the Journal of Patient Experience, validated for the most common settings of any hospital, free to use with authorisation.
Diana Bardales, 2026 
9 min 
Satisfaction surveys are the most widely used tool for understanding patients' opinions, and they have a clear value: they capture the overall perception of care and allow its evolution to be tracked over time. The rating partly depends on each patient's expectations, which makes it difficult to compare services or centres and does not always indicate which specific aspect needs improvement.
By condition or pathology: This means measuring specific processes, such as oncology care, cardiology or a surgical speciality. It makes sense when you want to go deeper into integrated practice units or specific programmes.
PREM questionnaires (Patient Reported Experience Measures) work differently. Instead of asking for an opinion, they ask about concrete facts that the patient can confirm and that the team can correct if they fall short.
| Topic | Satisfaction question | Experience question (PREM) |
|---|---|---|
| Discharge information | How would you rate the information given at discharge? | Were you told what to do after leaving hospital? |
| Treatment received | Are you satisfied with the way staff treated you? | Were you addressed by your name at all times? |
Illustrative examples, not verbatim transcriptions of validated questionnaires.
Those questions measure satisfaction, not experience. If you want to incorporate experience measurement, there is no need to rewrite them yourself: the most efficient approach is to complement or replace them with an already validated PREM questionnaire, following the steps in this guide.
Step 1: Select the areas you want to measure
Each care setting involves a different patient journey, and PREM questionnaires are designed and validated for a specific setting. That is why the first step is to define what will be measured and by what criteria the results will be segmented. There are two possible approaches, which are compatible with each other.
By care setting: This means measuring the major settings common to any hospital, such as inpatient care, emergency care, outpatient clinics or major ambulatory surgery. It is the most useful option for getting an overview of the centre and comparing services and hospitals with each other.
By condition or pathology: This means measuring specific processes, such as oncology care, cardiology or a surgical speciality. It makes sense when you want to go deeper into integrated practice units or specific programmes.
The two approaches are not mutually exclusive. The usual approach is to start with the highest-volume settings and add condition-specific questionnaires later or according to specific needs.
Segmenting by setting allows each unit to work with its own results, without losing the overall picture provided by the global score. The difference between settings can be considerable: in the Vall d'Hebron, IEXP and RateNow study, NPS ranged from over 80 in paediatric outpatient clinics to just over 20 in telemedicine visits.
Step 2: Find validated questionnaires in the literature and in your language
Designing and validating a questionnaire from scratch is time-consuming and costly. In the Vall d'Hebron study, between the cognitive testing with patients, the psychometric analysis and the cultural adaptation, the process took almost two years. That is why the sensible approach is to start from tools that others have already validated.
When searching the scientific literature (Journal of Patient Experience, PubMed or other healthcare quality journals), check four things:
Setting: The questionnaire must be designed for the setting or condition you selected in step 1.
Validation: It must have a published validation: patient testing, factor analysis and reliability measures.
Language and population: It must be validated in your patients' language and, if possible, in a healthcare context similar to yours. A questionnaire translated without cultural adaptation loses part of its validity.
Terms of use: Check whether it is freely available, requires authorisation or has a cost.
For hospitals in Spain, the most direct starting point is the five PREM questionnaires validated by Vall d'Hebron, IEXP and RateNow:
- Inpatient care (adults)
- Outpatient clinics (adults)
- Outpatient clinics (paediatrics)
- Emergency care without admission
- Major Ambulatory Surgery
They are validated in Spanish, culturally adapted into Catalan and English, and have been tested in 11 hospitals across Andalusia, Asturias, Catalonia and Madrid. The study analysed more than 400,000 patient responses.
Step 3: Request authorisation from the authors (or pay the licence fee)
The fact that a questionnaire is published does not mean it can be used freely. Many validated PREMs are protected by copyright. Some are free subject to authorisation; others require paying a licence fee or royalties.
Before launching it, contact the authors or the rights-holding entity. This ensures you are using the correct version and complying with the terms of use, which sometimes include not modifying the items or citing the source in reports.
In the case of the five questionnaires from Vall d'Hebron, IEXP and RateNow, use is free of charge, but any hospital wishing to apply them must request authorisation.
An important note
If you modify the questions in a validated questionnaire, you lose the validation. If you need to add something of your own, do so as additional questions separate from the validated block.
Step 4: Test the questionnaire with a small group of patients
Even if the questionnaire is validated, it is worth running a pilot at your centre before rolling it out to all patients. No large-scale study is needed. A small group of patients from each setting is sufficient, and the test can even be done manually, on paper or on a tablet in the waiting room.
The pilot is used to identify practical issues. For example, whether patients understand the questions in your context, whether the response time is reasonable, whether the timing of the send is appropriate and whether your team knows how to interpret the results. It is also a good opportunity to involve professionals from each unit from the outset.
As a reference, in the original study, focus groups with patients were used to adjust the wording of almost all the items and include aspects that patients felt were missing, such as being able to resolve doubts after discharge. That work has already been done in a validated questionnaire. Your pilot only needs to confirm that it works in your centre.
Step 5: Automate the send to reach the right patient at the right moment
A good questionnaire sent too late, to the wrong patient or irregularly loses almost all its value. To measure continuously and enable comparison, the send must be automatic, universal and linked to each care episode. Each patient should receive the questionnaire for their setting, shortly after their visit, without depending on someone distributing it by hand.
This is what a platform like RateNow does. It integrates with the hospital's systems, sends the appropriate questionnaire to each patient by SMS after their visit and segments each response by hospital, service and questionnaire. Each unit then sees its own results in real time. It is the same infrastructure used in the multicentre study: more than 400,000 responses between November 2022 and November 2025, with an average response rate of 24%.
On NPS: The five questionnaires in the study end with a Net Promoter Score question. It is a useful summary indicator for tracking the trend, but it should complement the experience questions, not replace them. The NPS tells you whether something is going well or badly; the PREM items tell you what you need to change.
Summary
| Step | What to do |
|---|---|
| 1. Select settings | Decide whether to measure by care setting, by condition or both |
| 2. Find validated tools | Prioritise questionnaires validated in your language and context |
| 3. Request authorisation | Respect copyright and do not modify validated items |
| 4. Run a pilot | Test with a small group of patients, even manually |
| 5. Automate the send | Send each questionnaire to the right patient at the right moment |
If you want to apply the validated PREM questionnaires from Vall d'Hebron, IEXP and RateNow in your hospital, or migrate your current satisfaction surveys to PREMs, let's talk.
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 satisfaction survey and a PREM?
A satisfaction survey asks for a rating ("how would you rate the care?"), and that rating depends on each patient's expectations. A PREM asks about verifiable facts. This means results can be compared across services and centres, and each unit knows what it needs to correct.
Do I need to design and validate my own PREM questionnaire?
It is not necessary. Validating a questionnaire from scratch requires patient testing, psychometric analysis and cultural adaptation, and can take almost two years. The most efficient approach is to use questionnaires already validated and published in the scientific literature.
What is the best way to send PREM surveys?
The ideal approach is an automatic send, linked to each care episode, that delivers the appropriate questionnaire to each patient shortly after their visit. Platforms like RateNow do this by SMS and segment results by hospital, service and questionnaire.
Are the PREM questionnaires from Vall d'Hebron, IEXP and RateNow free of charge?
Yes. They are free to use and available in Spanish, Catalan and English. They are protected by the consortium's copyright, so each hospital must request authorisation before applying them.
How can I obtain the questionnaires?
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.
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