Background. The primary aim of this study was to develop and validate a short psychometric instrument to assess the patient's perception of the quality of anaesthesia. Methods. In Part 1, the Perception of Quality in Anaesthesia (PQA) questionnaire was developed, pilot tested, and validated. Attributes of high-quality anaesthesia were identified using a process that restricted input to patients and members of the public. In Part 2, patient cohorts completed the PQA before, and after, a 6 month period where anaesthetists were given individualized peormance data using questions from the PQA. Results. In Part 1, items in the PQAwere identified and ranked by 120 patients and members of the public. Validity and reliability of the PQA was assessed by 714 patients. Principal component analysis showed that the PQA comprised five factors: Attention/gentleness; pain management; information/confidence; postoperative nausea or vomiting (PONV); and concerns addressed. In Part 2, there were 2046 patient participants in the pre-feedback cohort, 4251 in the feedback cohort, and 1421 in the post-feedback cohort. Unsatisfactory experience in at least one PQA factor was described by 45.2% [95% confidence interval (CI) 43.1-47.4%] during the pre-feedback period, and 35.0% (95% CI 32.6-37.6%) during the post-feedback period. Conclusions. We developed and validated a patient-derived questionnaire to measure the patient's perception of anaesthesia quality. PONV, postoperative pain management, and communication with the anaesthetist are the most important features of the patient's experience. Feedback of PQA peormance scores to anaesthetists can lead to improved patient experience. © The Author . Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.