Christie Survey toolkit

1. Survey toolkit
Last updated July 2021

2. Introduction
• This toolkit provides support for
conducting patient and /or staff surveys at The
Christie
• These can be:
– National surveys e.g. National Inpatient Survey
– Local surveys e.g. patient satisfaction
• Surveys which are part of Research need to be
separately approved via Ethics committee

3. Survey toolkit
Content
• Before you start
• Approval process
• Survey design
• Questionnaire design
• Information Governance
• QICA team support

4. Before you start
• Is your survey really necessary?
– Why are you doing the survey?
• If you are thinking of making changes, are those in charge
committed to acting on the survey findings
– Is it possible to get the information any other way?
• Other departments may have the information, other surveys may
have been done. See our HIVE pages for a list of existing /
previous surveys.
Remember:
patients at the Christie and their families are under a lot of
stress and we should only be asking for their time to
complete a questionnaire if it is necessary

5. Survey types
• When a patient survey is part of a national audit or project, this still needs to be
registered.
• The QICA team may already have the details. You can check with the-
christie.clinical.audit@nhs.net before completing the proposal form
• The QICA team can still provide support for national surveys if needed
National surveys
Christie patient surveys
• All surveys carried out with Christie patients need to be registered using our
survey proposal form
• Use this Survey Toolkit to help design, carry out and complete your survey
• Support can be provided by the QICA team if required
Staff surveys
• Surveying staff views can be useful as a part of quality improvement, clinical
audit or service evaluations that are registered by the QICA team
• Check with Workforce / Human resources if you are thinking of carrying out any
other type of staff survey.

6. Approval process
• All patient and staff surveys need to be registered.
• This is to ensure :
–
–
–
• A simple survey proposal form can be found here
 All surveys are of a high quality
 The Trust has a central record of survey activity
 Identify any potential overlap and links between different
projects
Think about
 Topics you will cover – what will you do with the information you have gathered.
 Who is the target population and who will you select from the target population.
 How long will it take to get to the required number of respondents
 Who is available to help with the survey : be realistic – distributing
questionnaires and inputting results can be time consuming

7. Approval to completion process
What happens once we receive your proposal form:
1. A member of the QICA team will review the content
2. We will be in touch if there are
1. Any questions
2. If we can identify any similar projects or possible stakeholders to
involve
3. Once approved, you will receive a notification email, with the
project number.
4. Please see a copy our report template. When you send us a
copy of your findings / report once the project is complete,
we will update our registration database.
5. If the report is not received by the expected due date, a
reminder will be sent. You can advise any reasons for delay
and request more time if required to complete.

8. Survey Design : Patient selection
How you are going to select your patients
• Unless your patient group is very small, we advise approaching a sample.
The size will depend on the patient group, the questions and your capacity
• Aim to have results you can draw conclusions from – this can typically be
50-100 responses.
List from Data
Insights or CWP
In clinic, face to face with
patients or at the end of a
tel/video consultation
Using own database
of patients
decide on how you will
select patients in a
non-biased, systematic
way if possible e.g.
every 10th patient
if you are selecting from a clinic, ask
all patients over a range of dates /
times, so that you can maximise the
spread of patient types. E.g. all
patients over a 2 week period could
be given a paper form or consented
to receive an electronic form via
SMS or email.
a request can be made
to data insights via Tech
Bar [link to form] to
provide a list of patients
who fulfil your criteria
e.g. New breast patients
seen between January
to June 2021

9. Survey Design : Patient selection
How you are going to select your patients
• Consider the following response rates for past Christie surveys, to help
determine the numbers you might need to approach/contact
Response rate Numbers to approach
to get approx. sample
of 50
Paper posted Up to c.40% 125
Paper handed out in clinic Up to 60% 85
SMS – unsolicited 2% 2500
SMS / Email– pre consented * 79% 65
Completion rates are higher when patients are asked first, especially for SMS / email
You MUST consent patients to participate in a survey if you are collecting patient
identifiable data (PID). However, we would not recommend collecting PID.
*Note – SMS / Email – pre consented in table above is based on a small sample 15/19
patients, and the SMS was sent out straight after the consultation

10. Survey Design : Data collection
• Method of Data collection
There are a number of different ways to carry out your survey. All of the
following methods can be supported at The Christie for registered projects.
Contact the QICA team for further support.
Paper
questionnaire (via
Post or by hand in
clinic)
On-line survey – via
SMS, Email or QR
code
Face to face with a
member of staff (collect
results on-line or on
paper)
If you are planning a postal mailing to patients, we can supply a Freepost return
address – there may be a charge depending on your sample size
An SMS batch mailing is also an option, but may incur a cost depending on sample size
Prior to sending a postal survey or a batch SMS/Email, patient status must be verified
and any deceased patients removed from the list. This can be done by carrying out a
Death Trace query (via the Data Insights team)

11. On-line survey via SMS, email or QR code
 Online survey easy to create and
distribute
 Patients complete on a mobile device
 Easy for patients
 No need to data entry the results
 Shorter time scales
 Poor response rates, especially with unsolicited
surveys
 Some patients may not use devices
 Limited email information held for patients
 Self completion – patients miss questions
 Can be a cost depending on your sample size
Survey Design : Data collection
Advantages Disadvantages
Paper questionnaire
 Easy to hand out in clinic
 Can also include a QR code
 All patients are accessible
 Postal version means can include all
patients / patients not seen for a
while
 Need to check patient status (run a death trace)
 Time consuming to hand out / post out
 Cost of postage
 Results have to be input by a team member
 Longer timescales
 Longer questionnaires can be off putting
 Self completion – patients miss questions
Face to face questionnaire
 All questions answered because
assisted to complete
 No need to data entry results if using
a device
 Time consuming for staff
 Usually for small sample sizes

12. Questionnaire Design
• All Christie surveys must have:
 Christie logo
 Introduction to explain its anonymous, confidential and voluntary – see example
wording for covering letters to patients or an SMS to patients
 Instructions on how to send back the survey
• Example questionnaires at The Christie
At The Christie we have conducted many patient surveys.
• Paper surveys - A selection of previous paper surveys
• On-line surveys – Take a look at an Example survey, show casing some of
the standard template questions you could consider
Take a look at our further Tips and examples for survey and
Questionnaire design
Please Contact the QICA team if you would like advice on your questions

13. Questionnaire Design
• NHS England guide bitesize-guide-writing-an-
effective-questionnaire.pdf (england.nhs.uk)
• At The Christie we use SNAP surveys software, but
Survey Monkey also has some useful tips and advice
on their pages.
Six Rules for Writing Survey Questions (snapsurveys.com)
Survey Best Practices & Design Guidelines | SurveyMonkey
• Please ask about using SNAP for your survey, before
utilising Survey Monkey
• Survey Monkey is not considered secure for patient
identifiable information
• General questionnaire design advice – other sources

14. Information Governance
• It is the responsibility of the project lead (i.e. the lead person carrying out the
survey, interview, or focus group) to ensure that the Trust's Information
Governance and Data Protection policies are adhered to at all times. Further
information can be found on the Trust's intranet: HIVE - INFORMATION
GOVERNANCE AND SECURITY OPERATING FRAMEWORK (xchristie.nhs.uk)
• You must consider:
– If you are doing a postal survey or unsolicited SMS/email you must do
everything you can to ensure that a questionnaire isn't sent to someone
who has died. If you submit a data request via the Tech Bar, with your
patient list, the data insights team can then run a death trace for you.
– National Data opt out – if patients have consented, there is no need to
check they have not opted out. Similarly, if all results are anonymised,
there is no need to check their Opt out status. For all other situations, you
must check that the patients in your sample have not opted out, before
you contact them
– Surveys are confidential and voluntary
– Your survey should not collect PID. If this is needed, patients must be
consented
– Results must always be anonymised when reporting

15. Share learning! Celebrate success!
Reporting and publishing surveys
Share learning internally first but….
• Worth considering if you might want to publish your survey results
at the outset, to ensure all elements of best practice included
• Likely to need evidence of governance and ethical considerations
have been addressed (eg QICA approval of project)
• Christie report template can be used for your local reporting.
• Consider how you will communicate the results back to patients
– Christie website or social media
– Noticeboards
You said, we did

16. Survey Checklist
 Patient selection
 Checked you are asking/approaching the right patients
 Included enough patients to get your preferred final sample
 Run a death trace (if applicable)
 Checked patients have not opted out of surveys
 Consented participation (if applicable)
 Advised patients its anonymous & confidential
 Provided a freepost envelope (if applicable)
 Questionnaire
 Piloted your questions with a couple of patients
 Tested any QR codes and survey links work (if applicable)
 Checked spelling and layout
 Results
 Decided who will data entry (if needed)
 Determined how you will analyse results
 Set a deadline to close off results
 Set a realistic deadline for project completion
 If you want to publish, have you checked your survey methodology will be acceptable
 Decided how you will feedback results to patients (aggregated)
Final checks before you start your survey: Have you?

17. QICA team
• Contact the QICA team for help with all aspects of
surveys at:
– the-christie.clinical.audit@nhs.net
• You can also find further information on Surveys and
Quality improvement on our QICA pages on HIVE :
– Hive - departments - Quality improvement and clinical audit
– Christie QICA toolkit 2020
– QICA project list and summary
– E-learning, templates and more
– QICA Project proposal form