CAHPS Clinician & Group Narrative Item Set

Originally known as the Narrative Item Elicitation Approach, the first CAHPS Narrative Item Set asks patients about their experiences in ambulatory care settings. The items were developed to be used with the CAHPS Clinician & Group Survey (CG-CAHPS) but they can also be used on their own.

Questions in the Narrative Item Set for the Clinician & Group Survey

There are two slightly different versions of the Narrative Item Set for the Clinician & Group Survey:

• A Narrative Item Set for the Clinician & Group Survey 3.0/3.1, which asks patients about their experiences over the last 6 months: These supplemental items are available in English and Spanish for both the Adult and Child versions of the survey.
  • Review the CG-CAHPS 3.0/3.1 Narrative Item Set for adults.
  • Review the CG-CAHPS 3.0/3.1 Narrative Item Set for children.
• A Narrative Item Set for the Clinician & Group Visit Survey 4.0 (beta), which asks patients about their most recent visit: These supplemental items are available in English for the Adult version of the survey.
  • Review the CG-CAHPS Visit Survey 4.0 (beta) Narrative Item Set for adults.

There are six questions in the Adult version and six questions in the Child version. In the Adult version:

• The first question asks respondents to say what they are looking for in a healthcare provider and that provider’s staff. 
• The second question asks respondents to comment on their providers and providers’ staff. 
• The third and fourth questions ask respondents to elaborate on what went well or could have been better. 
• The fifth question asks about the relationship between the patient and the provider. 
• The sixth question asks respondents what they would change about their interactions with providers and those providers’ staff.

The sixth item in the Adult version uses a narrative elicitation approach to gather patients' creative and actionable ideas for improving their healthcare experience. It prompts patients to proactively suggest changes, making it especially valuable for healthcare organizations seeking continuous improvement and innovation from patient insights. 

The questions for the Child version are the same, except that the fifth question asks specifically about the parent and provider's relationship; and a sixth question asks about the relationship between the child and the provider. Also, the question about what respondents would change about their interactions with their providers is not included in the Child version.

Because of the sequential design of the questions, they are meant to be used together in the order specified. For example, the first question is designed to prompt respondents to state the most important things they look for in a health care provider so that they have those things in mind when answering the subsequent questions. 

Survey Placement: The sixth question referring to what respondents would change about interactions with providers and staff should be placed after the CAHPS Narrative Item Set for the Adult Clinician and Group Survey, as the sixth question following the five existing narrative items. These preceding questions encourage patients to reflect on their care experiences, interactions with providers, and areas for improvement. This item serves as a final prompt that shifts the focus from assessment to solution-generation and enhances the survey with forward-looking, innovative feedback. 

The CAHPS team strongly recommends against reordering the questions or selecting a subset of the questions for partial use.

Administering the Clinician & Group Narrative Item Set

Organizations interested in using the CG-CAHPS Narrative Item Set can consult Administering the CAHPS Clinician & Group Narrative Item Set (PDF, 295 KB). This guidance is based on the testing of these items in real-world conditions and addresses the following issues:

• Placing the items in the survey.
• Using the items on their own.
• Introducing the items.
• Editing the items.
• Drawing a sample.
• Collecting the data.
• Invitations and reminder letters and emails.
• Anticipated response time.
• Anticipated length of comments.
• Oversight of vendors.

Learn More About the Clinician & Group Narrative Item Set (Elicitation Approach)

• Article: Lee, Y. S. H., Grob, R., Nembhard, I., Shaller, D., & Schlesinger, M. (2024). Leveraging Patients' Creative Ideas for Innovation in Health Care. The Milbank Quarterly 102(1), 233-269.
• Webcast: Learning from Patient Narratives Through Innovative Feedback Reporting Methods (Webcast) (May 31, 2023)
• Webcast: The Power of Patient Stories for Improving the Patient Experience (Webcast) (May 12, 2022)
• Webcast: CAHPS Patient Narrative Item Sets (November 16, 2021) 
• Webcast: Implementing the New CAHPS Protocol for Obtaining Patient Comments About Their Care (October 2018)
• Webcast: Introducing a Protocol To Obtain Patient Comments Using the CAHPS Clinician & Group Survey (January 2017)

Brief History

The original beta version of the Clinician & Group Narrative Item Set was released in early 2017. In June 2021, AHRQ released the final versions of these items for the 3.0/3.1 and 4.0 versions of the Clinician & Group Survey.

Learn more about the development of the CAHPS Clinician & Group Narrative Item Set.