Improving quality of care through the OECD Patient Reported Indicator Surveys (PaRIS)

5. Key lessons and recommendations

PaRIS Cycle 1 generated five key practical lessons for dissemination and communication, analysis and policy use. (1) Early steering and advisory bodies helped tailor communication activities and turn results into next steps. (2) Targeted engagement with healthcare professionals and patients helped to close knowledge gaps on PROMs and PREMs. (3) Dedicated budgets and the reuse of existing resources supported dissemination. (4) Alignment with national reforms and data institutions enabled uptake. (5) Closer links between project teams and policymakers, alongside institutionalisation, helped mitigate competing priorities and fragmented governance. Moreover, countries expressed interest in joint research to share efforts and strengthen findings. This section presents the key lessons from PaRIS Cycle 1, particularly challenges and enablers concerning communication, use and sustainability activities. It also provides recommendations to facilitate the use of data for health policies, based on the learning from the OECD PaRIS Cycle 1.

The first cycle of PaRIS created practical learning opportunities for all groups involved, from survey design, fieldwork, analysis, communication and policy use. The unprecedented scope of collecting PROMs and PREMs at an international scale meant teams had to build capacity, test governance and data flows, and refine how results are translated for decision makers. The findings that follow translate these lessons into actions that countries can adapt to their context, with a focus on strengthening governance and resources, tailoring communication to different audiences, and ensuring the collaborative effort of stakeholders.

Establishing steering and advisory bodies at early stages facilitated the dissemination of results and the use of findings

Early, structured engagement made PaRIS more relevant in each national context. Steering and advisory bodies brought ministries, primary care professionals, academics and patient groups into the process from the outset, which kept communication consistent and tailored outputs. By creating a clear forum for interpreting results, these groups eased dissemination and helped convert evidence into practical next steps.

Establishing steering committees from early stages brought key stakeholders on board and facilitated dissemination

Across participating countries, establishing governance arrangements early provided a practical forum to organise dissemination of PaRIS results. In Australia, a PaRIS Governance Committee brought together representatives from consumer, professional and Aboriginal community‑controlled health organisations and research councils, Primary Health Networks, digital health agencies and academic partners. The Committee played a key role in communicating and promoting the initiative to relevant organisations, advising on appropriate stakeholders for consultation and involvement, and representing the perspectives of key stakeholder groups in shaping the project. Additionally, The Royal Australian College of General Practitioners (RACGP) assisted in promoting the PaRIS Survey and its results through its website and communication channels, including a media release and commentary at the launch of the Australian national report. Belgium convened a steering committee from the outset, that brought together scientific and health authorities, the national health insurance institute, regional health agencies, academic partners, general practice organisations and patient representatives from both Flanders and Wallonia. In Portugal, an advisory board was in place from the initiation of PaRIS and met ahead of the release to review results and steer the launch, with patient and professional organisations closely aligned and active in dissemination. In both Belgium and Portugal, the committees reviewed written outputs, supported the national conference and ensured that perspectives from different parts of the system were reflected. In Romania, a consultative council bringing together relevant health‑system stakeholders was established following the PaRIS field trial and served as a consistent source of guidance throughout the project. Following the release of the results, the consultative council concluded that a strategic plan should be developed to guide the implementation of changes informed by the PaRIS findings. In Saudi Arabia, the steering committee gathered the main system actors, including the Centre for National Health Insurance, the Ministry of Health, primary care leadership, the Health Sector Transformation Programme and the patient‑centred experience unit, creating a channel to engage experts across sectors and discuss how the findings could be used in practice. Slovenia combined ministry leadership with involvement from community health centres, the National Institute for Public Health, alongside representatives of nurses, family doctors and other healthcare professionals. The ministry was central to supporting the preparation of results and co‑ordinating the involvement of key stakeholders through its established networks.

Stakeholder groups and advisory bodies supported the contextualisation of findings and identifying priority areas

Stakeholder groups have helped interpret PaRIS evidence in local contexts and identify priority areas. In Australia, PaRIS results have been used by the Royal Australian College of General Practitioners in broader policy advocacy highlighting the need for investment in Medicare to support continuity of care and longer consultations, particularly for patients with chronic conditions. In Belgium, the steering committee co-produced the national report and was described as essential in identifying priorities such as increased investment in care plans and providing direction. In Canada, stakeholder engagement was integral to data collection: in Saskatchewan, a partnership with an Indigenous community embedded patient‑oriented research and mobilised more than 50 people to work with the provincial lead through cycles of engagement, and in Québec there were monthly touchpoints with 13 to 14 clinics during data collection which created a collaboration. In Greece, the Panhellenic Medical Association worked with academia and government to align the findings with efforts to rebalance staffing between remote and rural areas. National patient organisations were also engaged throughout, including the cancer patient association and the national longevity centre, to shape survey design, dissemination and follow‑up. Additionally, the national nurses’ association held a dedicated panel at nursing conferences to translate findings for frontline practice. Italy involved healthcare professionals in both collection and interpretation at the regional and local health authority level and included them in dissemination, which supported implementation. In Norway, the national reference group with representatives from patient organisations, GPs, policymakers and researchers discussed the results from the PaRIS survey and helped contextualise the results. The Norwegian Institute of Public Health and the patient organisations also collaborated on a research news article about OECDs Flagship report and with comments on the main Norwegian results. Portugal’s ministry‑hosted stakeholder dialogue brought together the ministry, ACSS, patient and practice stakeholders and translated the findings into three concrete policy priorities and a plan for follow up (Section 2). In Switzerland, the advisory body ensured the results were interpreted through a regional lens, emphasising the canton‑specific perspective to reflect heterogeneity in service organisation and to guide targeted follow‑up. Wales drew on well-developed links with national clinical networks and clinical leads from local health boards who they regularly worked with to interpret results and guide system‑level transformation.

Limited familiarity with PROMs and PREMs constrained communication and policy use, but targeted engagements promoted further understanding

In many countries, a lack of familiarity with patient‑reported indicators and their use constrained dissemination and communication of PaRIS results among healthcare professionals and policymakers. In Czechia, PROMs and PREMs methodology and use was new for primary care and further communication was considered a priority. Greece reported limited familiarity among stakeholders and a need to deepen health literacy on PREMs and PROMs; while discussion has started, understanding was not yet at a level that supports everyday decision and policymaking. Limited familiarity among patients with patient‑reported measures also affected dissemination. Greece reported patients were not aware of the importance of assessing their own experience, due to the lack of tradition in collecting patient-reported experience measures, making participation and understanding a priority for future initiatives. In Saudi Arabia, uncertainty about the meaning and application of patient‑reported data, combined with the newness of the project, left providers unsure how to use results for decision making and what policy actions to take from the first cycle.

Targeted engagement with stakeholders can promote further understanding of patient-reported measures

Targeted engagement of stakeholders on patient-reported measures could help address barriers and make findings more actionable. Greece explicitly addressed the lack of familiarity with patient-reported measures by convening dedicated sessions to explain what PROMs and PREMs capture and how they can be integrated into routine practice. Additionally, for patients, Greece is making participation and understanding of patient-reported measures a priority for future initiatives.

Other countries also spoke directly to healthcare professionals to build familiarity and contextualise results. Luxembourg is planning workshops and seminars with healthcare professionals to take discussions beyond infographics and general feedback. Saudi Arabia organised general information webinars as part of their webinar series, focussing on introducing PROMs and PREMs. This approach plans to increase awareness and knowledge ahead of the wider distribution of the international and national results. Slovenia presented results to healthcare centres during an education week on quality in healthcare. Wales brought tailored findings to NHS clinical group meetings and adjusted messages to the needs of each audience. These approaches can help strengthen understanding and support more confident use of patient‑reported evidence over time.

Limited resources hampered dissemination and use, while the use of international resources have the potential to support countries

Limited analytical capacity, the absence of dedicated dissemination budgets and the scale of the dataset constrained further use of PaRIS results. In Australia, the significant time and resources required to interpret, contextualise and disseminate results to multiple stakeholder groups proved to be a barrier in dissemination. In Greece analysis fell largely to two academic leads and the lack of a dissemination budget made it difficult to plan and resource activities. In Iceland, a university‑led two‑person team faced limited capacity to analyse and translate findings. In Italy, plans to incorporate PREMs at the national level are slowed by the absence of digital infrastructure and incomplete data flows across regions. In Saudi Arabia, the size and complexity of the dataset challenged stakeholders’ ability to interpret results without additional synthesis. The Netherlands cited a limited budget as a limitation to dissemination and use of the PaRIS results. In Wales, the team reported they would have liked to do more dissemination and data analysis however the small team restricted the amount that could be undertaken.

Use of PaRIS‑10 Indicators helped countries guide their outputs

The PaRIS‑10 indicators were widely used by countries and guided dissemination and communication in many national reports. Many countries, including Australia and Belgium, used the PaRIS‑10 as a core frame for reporting to the community, with the radar chart providing a quick way to communicate comparative performance. Additionally, the metrics are being taken further, with Norway integrating selected PaRIS‑10 indicators into its PREMs survey and Spain planning a report on each of the ten indicators in the Spanish context. The use of these metrics provided a common foundation for countries to structure their dissemination.

Countries expressed a desire to increase research collaboration between participating countries to enrich academic results

Countries indicated that collaboration on academic research could help extend capacity and enrich outputs. Norway noted that planning and co‑ordinating research projects with similar goals across more than one country will strengthen academic research and add value. Wales expressed interest in more international collaboration so that when one country invests in a topic others can align, and the combined output is richer. Cross‑country work is already emerging, with Belgium, Luxembourg and Switzerland undertaking a joint study on perceptions of care co‑ordination. These collaborative approaches can share analytical effort, support common methods and produce findings that are more useful for policy.

Including a budget line for dissemination and release of results can ensure broader outreach

Allocating dedicated resources for dissemination helps teams plan design, production and timely release of outputs. Australia engaged with established media contacts through the Commission’s communications team to obtain media coverage of the PaRIS initiative and the Australian results. In Canada, teams noted increased engagement among decision makers when results were accompanied by clear visuals or practical tools and noted that allocating specific resources to dissemination was essential. One provincial team employed a graphic designer who developed templates that were reused by other provinces, which expanded impact. Teams also highlighted that the window of opportunity following a major release is short, so effective dissemination strategy was important. Greece aims to address constraints in resourcing for dissemination by requesting additional funds for dissemination in a second cycle. These experiences indicate that a defined budget line for dissemination can improve accessibility, timeliness and uptake of results.

Competing national priorities hampered the use of PaRIS results while alignment with national reforms and capacity enabled it

In several countries, pressures on healthcare access and the workforce reduced the space to act on PaRIS insights and made it harder to keep PaRIS findings prominent in policy discussions. In Canada, policy attention is concentrated on access to care, and the fiscal climate with federal staffing reductions and provincial deficits has made it challenging to prioritise new patient‑experience measurement when there are immediate issues such as keeping emergency departments open and addressing workforce pressures. Similarly, France mentioned the policy priority of access difficulties, notably in medical deserts. Portugal described the same challenge of agenda‑setting, noting that media and political pressure around the lack of family doctors and overloaded emergency departments kept access above quality in the hierarchy of priorities. Romania indicated that financial constraints, alongside wider contextual pressures beyond the national health system, constrained the use of PaRIS results for policy development. In Slovenia, public roundtables with patients and clinicians quickly centred on workforce shortages and why people could not see their chosen family doctor, making it difficult to communicate the results without first addressing those immediate problems. In addition, the variations in response rates across countries made some countries like Belgium, France and Norway, more cautious about the use of data for health policies.

The European Union funded National Recovery and Resilience Plans (NRRP) have also shaped timelines and priorities for PaRIS at the national level, especially in digital health. In Portugal, NRRP projects took precedence, so a national platform for PREMs and PROMs was deferred because it was not in the initial plan; the intention is to use PaRIS indicators to specify standards and integration once NRRP milestones are met. Conversely, in Italy, NRRP funding accelerated digital health investment, and authorities plan to use PaRIS Cycle 2 to assess whether these investments improved access, experience, continuity and equity across regions.

In addition, the waiting period between the data collection and the publication of the flagship results challenged countries in maintaining momentum with stakeholders and policymakers. In Australia, the time to receive the international results and reporting materials, constrained the national project management teams capacity to provide timely reporting to participating practices. In Canada, the waiting for the international results also challenged the national project management team to keep policy attention on PROMs, PREMs, and their use for policymaking. In Norway, the nearly 2‑year waiting period between measurement and the release of results made it challenging to keep the attention of participating general practitioners, ultimately resulting in little interest in provider level reports when the results were published.

Countries aligned PaRIS with their national priorities and joined forces with other stakeholders

Implementation of PaRIS was influenced by existing data institutions, performance monitoring capacity and alignment with ongoing reforms. Countries engaged national statistical and analytical bodies to leverage data and ensure compliance. In Czechia, work with the national institute of health statistics helped navigate GDPR and regulatory requirements, with planned co‑ordination on efforts to embed PROMs and PREMs in routine monitoring. In Greece, collaboration with the national statistical service supported access to and interpretation of data for policymaking; and in Wales, Digital Health and Care Wales led data management, digital infrastructure and analysis. Some countries like Spain, Norway and Wales excelled at implementing PaRIS in their national context, reaching the target sample size. Extra sampling in Wales enabled them to conduct further analysis on the national dataset to gain a better understanding of policy priorities.

Capacity to act on findings was strengthened where performance and quality monitoring institutions were readily available: in Belgium, PaRIS data will be used by the Belgian Health Care Knowledge Centre (KCE) to report on care evaluation, including primary care performance. Alignment with national strategies further supported uptake: in Czechia, PaRIS complemented an ongoing primary care reform and provided evidence to continue and strengthen the reform; in Greece, PaRIS ran in parallel with initiatives to reorganise primary healthcare; and in Slovenia, Portugal, Saudi Arabia, national efforts on primary care and patient‑reported measurement were co‑ordinated with PaRIS.

Fragmented national governance of PaRIS made policy use more challenging, while closer link among different bodies supported translation into action

Where implementation teams sat apart from decision levers, or where authority was devolved, the use of PaRIS results proved more difficult. In Canada, the provincial and territorial organisation of the health system, combined with geographic spread, required a dedicated project lead in each jurisdiction to liaise with ministries and health authorities and this dispersed set up made translation of PaRIS results into practice more complex. In Spain, the devolution of healthcare delivery to autonomous communities meant the Ministry of Health, which was responsible for PaRIS, reported difficulty in tracking or co‑ordinating the use of PaRIS data, creating a gap between evidence generation and operational change. Similarly in Switzerland, responsibility for healthcare delivery is distributed across 26 cantonal health systems. Therefore, there is limited decision making capacity at the federal level on quality and service delivery, making the use of PaRIS data more challenging. In addition, some countries noted that a liaison function alone was not sufficient; strong ministry buy‑in, timely communication and action as well as shared ownership were needed to translate findings into practice.

Greater collaboration between national project managers and policymakers enhanced the use of results for health policies

Tighter co‑ordination between national project managers and policy leaders helped move from findings to concrete steps and mitigated some of these constraints. In Slovenia, the deputy project manager was responsible for national implementation and liaised with international affairs and finance, while the Ministry of Health acted as an enabler by helping prepare dissemination and convene stakeholders. The government also provided visibility that drew the right actors into the discussion. In Portugal, the national project manager sat within the Ministry of Health and now serves as Director‑General for Health, and a close consortium with the funder ACSS and subsequent policy dialogue helped turn results into concrete priorities.

Institutionalising PaRIS can help address competing priorities and dispersed authority by establishing routine processes for data collection and use. In Portugal, a ministerial decree to formalise governance would clarify responsibilities across agencies and support continuity across political cycles (see Section 4). Steps like these ensure PaRIS remains embedded in national systems and can continue to inform policy and practice over time. In Norway, a long‑standing and close dialogue between the Ministry of Health and the Norwegian Institute of Public Health on the PaRIS initiative helped ensure that findings from the flagship report were taken up in central policy initiatives, including their timely inclusion in a white paper on the future of general practice services.

From PaRIS data to supporting health policy: Key recommendations

PaRIS has changed the PROMs and PREMs landscape both at the international and national levels. Beyond the international publications and activities, countries produced national reports, academic papers, infographics and organised policy dialogues, stakeholder events and bespoke meetings. One year after the release of the flagship report, PaRIS data and results have served as a useful source of evidence for policy discussions.

Key lessons learned highlight that PaRIS Cycle 2 will be stronger when stakeholders are engaged at the very beginning in a continuous manner, as well as when knowledge and training are strengthened among patients, healthcare professionals and policymakers. Careful planning for budgeting, including dissemination and communication plans, as well as the use of international and cross-country resources will further support dissemination. The learnings also stress that a closer link between national project management teams and policymakers is beneficial so that PaRIS can align with and address policy priorities in a timely manner. Sustainability through systematic collection of PROMs and PREMs data across PaRIS cycles remains essential to move from data to health policy. Box 1 shares the recommendations to assist countries in their next steps for moving from PaRIS data and results to quality improvement in primary care.

Box 1. Data to health policy: Recommendations based on the OECD PaRIS

The findings from this report highlight several short- and medium- term recommendations for countries to strengthen the uptake of PaRIS at the national level:

• Convene a stakeholder group from early stages: Relevant stakeholders should be mobilised to discuss the study design in the national context, support recruitment and data collection, disseminate results, interpret findings, and develop policy priorities. Such a stakeholder group should include patients, healthcare professionals and other key stakeholders in the national context.

• Plan the communication and dissemination strategy ahead of time: Such a strategy should be developed with the stakeholder group and included as a budget line during project planning. The strategy should also consider the team composition and the relevant resources needed to realise the strategy, for example a communication officer, graphic designer or behavioural scientist.

• Ensure close collaboration between policymakers and project team: Establishing a steering committee that includes key actors in the implementation and use of results can strengthen impact. Such a committee should include the Ministry of Health, the national project manager (if not sitting at the ministry) as well as key national authorities and providers.

• Increase knowledge on PROMs and PREMs among patients, healthcare professionals and policymakers: Learning sessions should be planned to increase awareness, knowledge and learning capacity among key stakeholders including patients, healthcare professionals and policymakers. Invite key experts on the topic for the learning session to share high-level information as well as concrete examples of how to collect, communicate and use PROMs and PREMs.

The findings also point to several recommendations whose implementation will depend on continued, long‑term investment and effort:

• Commit to systematically assessing PROMs and PREMs at the national level: A national plan should prioritise the collection and use of patient-reported measures to assess the performance and quality of healthcare system. Maximise cross-country learning opportunities across PaRIS cycles through targeted collaborations.

• Invest in sustained systems (institutionalise) to systematically collect PROMs and PREMs data: Interoperability in data systems should be achieved to link data across databases to improve interpretability of the findings in the broader national context. Prepare legal frameworks, where needed, for governance and sustainability.