CAHPS Patient Narrative Elicitation Protocol

The CAHPS® Narrative Elicitation Protocol (beta version) is a set of open-ended questions that prompt survey respondents to tell a clear and comprehensive story about their experience with a health care provider. Narratives from patients about their health care experiences can provide a valuable complement to standardized survey scores, both to help clinicians understand what they can do to improve their care and to engage and inform patients about differences among providers.

Narrative Elicitation Protocol for the Clinician & Group Survey

The first Narrative Elicitation Protocol was developed to be used with the CAHPS Clinician & Group Survey. The protocol is available in English and Spanish for both the Adult and Child versions of the survey.

About the CAHPS Patient Narrative Elicitation Protocol (PDF, 410 KB) provides the beta version of these supplemental items as well as initial guidance on how to use them with the CAHPS Clinician & Group Survey.

Questions in the Elicitation Protocol for the Clinician & Group Survey

The beta version of the Narrative Elicitation Protocol consists of five questions that are intended to be asked together in the order specified:

  • The first question asks respondents to say what they are looking for in a health care provider and his or her staff.
  • The second question asks the respondent to comment on the provider and his or her staff vis-à-vis those characteristics.
  • The third and fourth questions ask the respondent to elaborate on what went well or could have been better.
  • The fifth question asks about the relationship between the patient and the provider.

In the Child version of the Narrative Elicitation Protocol, the fifth question asks specifically about the parent and provider's relationship; a sixth question asks about the relationship between the child and the provider.

Review the questions for adults.

Review the questions for children.

Testing of the Clinician & Group Version of the Narrative Elicitation Protocol

The CAHPS team is currently collaborating with NewYork-Presbyterian's (NYP) Patient Experience Team and Ambulatory Care Network (ACN) to assess the feasibility, value and use of the Narrative Elicitation Protocol in selected ACN ambulatory care practices. The research questions for this study include the following:

  • How feasible is the collection of narratives using the Narrative Elicitation Protocol in routine patient experience survey operations?
  • What is the added value of the Narrative Elicitation Protocol compared to conventional open-ended questions?
  • How can narrative information be reported to practice leaders and clinicians in ways that are easily understood and useful for improving patient experience?

Learn More About the Clinician & Group Version of the Narrative Elicitation Protocol

Narrative Elicitation Protocol for the Child Hospital Survey

As part of the CAHPS 5 research agenda, the CAHPS team is building on its work with the Clinician and Group Survey to develop and evaluate a Narrative Elicitation Protocol that will be suitable for use with the CAHPS Child Hospital Survey. Like the closed-ended questions on the Child Hospital Survey, the protocol is designed to be answered by the parent or guardian of the child; as a result, this work could inform the future development of narrative elicitation items in other settings (such as hospice) where proxies report on patient experience.

Brief History

In 2012, AHRQ began supporting research on eliciting patients' comments about their care through two grants: CAHPS IV and Building the Science of Public Reporting. The goal of this work has been to develop a method for collecting patient narratives that is as scientifically grounded and rigorous as the CAHPS closed-ended questions that are used to gather standardized data on patient experience. To that end, the CAHPS team created a set of open-ended questions that results in comments that meet the key criteria of being complete, balanced, meaningful, and representative.

Researchers affiliated with the Yale School of Public Health, RAND, and the University of Wisconsin-Madison worked collaboratively to develop and test open-ended survey items that could be incorporated into the CAHPS Clinician & Group Survey. The beta version of the Elicitation Protocol represents the results of this innovative research. These researchers are now collaborating to develop and test items for the CAHPS Child Hospital Survey.

Learn more about the development of the CAHPS Patient Narrative Elicitation Protocol.

For additional information, refer to:

  • Grob R, Schlesinger M, Parker AM, et al. Breaking Narrative Ground: Innovative Methods for Rigorously Eliciting and Assessing Patient Narratives. Health Serv Res 2016 Jun;51 Suppl 2:1248–72.
  • Schlesinger M, Grob R, Shaller D, et al. Taking Patients’ Narratives about Clinicians from Anecdote to Science. N Engl J Med 2015 Aug;373(7):675–679.
Page last reviewed February 2019
Page originally created December 2016
Internet Citation: CAHPS Patient Narrative Elicitation Protocol. Content last reviewed February 2019. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/cahps/surveys-guidance/item-sets/elicitation/index.html
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