Making patient experience actionable: applying importance-performance analysis to guide improvements in Swedish healthcare

TL;DR

This study uses Importance-Performance Analysis to identify areas for improvement in Swedish healthcare, particularly for patients with disabilities.

Contribution

The novel application of IPA to Swedish healthcare data reveals equity-related disparities not visible in average patient experience measures.

Findings

Most care dimensions for the overall sample were in the 'maintain performance' quadrant, indicating adequate performance on high-importance aspects.

Respondents with high disability levels showed significant performance gaps in relational continuity and professional knowledge.

IPA reveals disparities obscured by average metrics, suggesting targeted improvements for individuals with higher disability levels.

Abstract

Understanding how well healthcare systems meet what patients value is central to person-centered care. As a first objective of this study, the alignment between what Swedish patients consider important in healthcare and what they experience in practice was examined, using an Importance–Performance Analysis (IPA) across eleven relational and functional care dimensions. A secondary objective was to assess how these patterns differ by disability level, an equity-relevant factor shaping healthcare needs and expectations.

Anonymous survey data were collected from 1,036 adults across all Swedish regions who had accessed healthcare within the previous six months. Respondents rated the importance of, and experienced performance on, key care attributes including continuity, communication, shared decision making, timeliness, information access, and co-design. Mean importance and performance scores for each dimension were plotted in IPA grids for the full sample and for subgroups defined by self-reported disability due to long-term health issues (high, medium, none).

For the overall sample, most care dimensions fell into the “maintain performance” quadrant, indicating high importance and adequate performance, notably shared decision making, collaboration, communication preferences, responsiveness, and access to information. Relational continuity, informational continuity, support for self-care, and co-design were situated in the “lower priority” quadrant, reflecting lower relative importance and lower performance. For the total sample no dimensions appeared in the “focus efforts here” quadrant. Subgroup analyses revealed substantial inequities. Respondents with high levels of self-reported disability reported poorer health, greater difficulty accessing the knowledge they need, and lower performance ratings across all eleven dimensions. For this group, relational continuity and healthcare professionals' disease-specific knowledge shifted into the “focus efforts here” quadrant, indicating high importance coupled with significant performance gaps. These patterns were not observed among respondents with medium or no self-reported disability, for whom these dimensions were placed in areas indicating acceptable performance or lower priority.

The findings demonstrate that average patient-experience measures obscure meaningful disparities. IPA offers a practical decision-support method for identifying where improvement efforts should be targeted and for whom. Priorities for Swedish healthcare include strengthening continuity, enhancing informational support, and ensuring adequate professional knowledge for individuals with higher levels of self-reported disability. Used within iterative improvement frameworks, IPA can help move healthcare systems from measurement to meaningful, patient-informed change.

Figures