A digital, continuous, and systematic PREMs observatory implemented in Italian hospitals found increased participation and response rates over time. The real-time reporting of both quantitative and qualitative data, including positive patient narratives, is viewed as a valuable tool for service improvement and staff recognition at all hospital levels, including highlighting the contributions of often-overlooked care assistants.

The PREMs Observatory was financed by the Regions of Tuscany and Veneto. The funding bodies collaborated in the design of the surveys and the interpretation of results. Though the paper states funding bodies assured confidentiality of the survey via a third-party, their influence remains a possible conflict of interest.

This study presents a novel approach to collecting and using PREMs data, combining the strengths of traditional surveys with real-time feedback and narrative sections. The integration with a performance evaluation system and focus on positive deviance are noteworthy strengths. The study's ongoing nature and some methodological limitations regarding data analysis prevent a 5 rating, but it represents strong research with minor limitations.