Patient experience desk researchDanish LUP
Treat a national survey as a programme family
LUP is Denmark's national patient-experience programme. It is a family of surveys for different care settings and patient groups, rather than one questionnaire that every patient completes.
Best question it answersHow can one national programme support a common benchmark core and more timely local learning across different care settings?
What it teachesProgramme-family discipline: combine a protected core with setting-specific streams and governed local questions; use monthly results to improve services and annual aggregated results to compare performance fairly.
The problem it was built to solve
Unlike HCAHPS, which is built chiefly as a tightly controlled national hospital benchmark, LUP needed to give hospitals feedback specific enough to improve a service while also giving national and regional leaders a dependable view of differences in patient-experienced quality. It was designed to support both jobs: regular local learning and a yearly national comparison. See Danish LUP 2024 National Archive Catalogue and Region H LUP 2024 Programme Overview.
How it works
In 2024, LUP included Somatik, Fødende, Radiologi, Præhospital, and Psykiatri streams. LUP Somatik covers planned and acute inpatient and outpatient groups; its national results use eight common questions across all four groups, plus group-specific questions.
Departments can use local questions beside the national core. Somatik results are collected and reported monthly, while an annual status aggregates the prior year's data for national, regional, and hospital comparison. See DEFACTUM LUP Somatik Programme Operations, Danish Regions LUP Somatik 2024 National Results, and Region H LUP 2024 Programme Overview.
What it teaches us
Fair comparison
LUP shows that a score can only be compared fairly when you know which survey stream, patient group, collection method, and year it comes from. The annual status is the comparative layer, not simply a total of local scores.
The 2024 Somatik results also show why response context must travel with a result: response rates ranged from 35% for acute outpatients to 57% for planned inpatients. Danish Regions LUP Somatik 2024 National Results
Programme design and architecture
This is LUP's distinctive strength. A national programme can protect a common core while recognising that maternity, radiology, prehospital care, psychiatry, and different somatic patient groups are not the same experience. Local questions let services investigate their own priorities without silently changing the national comparison. DEFACTUM LUP Somatik Programme Operations
Scope of measurement
LUP has no single measurement level: its scope changes by stream. Somatik is chiefly episode measurement for a hospital stay or outpatient contact; Fødende is closer to a care pathway around pregnancy and birth; and Præhospital focuses on a specific emergency-care contact. The programme is national, but its instruments do not create one linked measure of a person's experience across all providers or of life impact after care. Region H LUP 2024 Programme Overview
Question design
The Somatik design shows a practical way to balance common and setting-specific content: eight national key questions are shared across all four patient groups, while waiting time and responsibility-for-the-pathway questions are only used where they fit. The lesson is to standardise the underlying experience construct where it is genuinely common, rather than forcing identical wording where the care context differs. Danish Regions LUP Somatik 2024 National Results
LUP also uses PREM questions: it asks about observable aspects of the care experience, such as whether staff were welcoming, listened to the patient, gave understandable information, or involved the patient in decisions. Danish Regions LUP Somatik 2024 National Results
Timing and actionability
Unlike a continuous feedback stream, LUP Somatik is a monthly digital survey cycle. Each month, feedback from the relevant inpatient and outpatient patient groups is analysed and reported through the BI portal; the annual status then aggregates the monthly measurements for comparison. This is not feedback during care, but it is much more actionable than a once-a-year survey cycle. DEFACTUM LUP Somatik Programme Operations
Digital and technology
LUP Somatik uses monthly digital surveys and a BI portal, but it also uses scheduled paper questionnaires to include people exempt from Denmark's Digital Post system in the annual status. This shows how a programme can use digital collection for speed while building in paper or assisted options so people who cannot use the digital channel are still represented. DEFACTUM LUP Somatik Programme Operations
Development and validation
LUP has documented patient testing across historic revisions. Before the 2006 fielding, the programme conducted 26 cognitive interviews to test question comprehension, response categories, length, and omissions; the preceding 2000-04 waves had involved 109 interviews. A 2018 validation exercise also informed a revised Somatik question about whether a doctor took responsibility for the patient's overall care course. Danish Ministry LUP 2006 Questionnaire Validation and DEFACTUM LUP 2018 Question Validation
The 2009 and 2014 redesigns also show active programme development: 2009 expanded the population and annual operating model, while the 2014 redesign followed a stakeholder evaluation and introduced new question, response-scale, and dimension architecture. Danish Ministry LUP 2009 Programme Redesign and the official 2017-18 Danish health-system review
Current boundary: the sources reviewed do not establish full psychometric validation of the 2022-24 monthly Somatik core. Danish LUP 2024 National Archive Catalogue
Evolution and modernisation
LUP has evolved as a programme family: Somatik moved to monthly measurement in 2022; acute outpatient patients joined Somatik in 2024; and Radiologi and Præhospital were introduced as new 2024 streams. The lesson is that comparability can survive change when each survey version is clearly tracked and governed. DEFACTUM LUP Somatik Programme Operations and Region H LUP 2024 Programme Overview
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