Abstract
BackgroundPatient satisfaction in health care constitutes an important component of organizational performance in the hospital setting. Satisfaction measures have been developed and used to evaluate and improve hospital performance, quality of care and physician practice. In order to direct improvement strategies, it is necessary to evaluate both individual and organizational factors that can impact patients’ perception of care. The study aims were to determine the dimensions of patient satisfaction, and to analyze the individual and organizational determinants of satisfaction dimensions in hospitals.MethodsWe used patient and hospital survey data as well as administrative data collected for a 2008 public hospital report in Ontario, Canada. We evaluated the clustering of patient survey items with exploratory factor analysis and derived plausible dimensions of satisfaction. A two-level multivariate model was fitted to analyze the determinants of satisfaction.ResultsWe found eight satisfaction factors, with acceptable to good level of loadings and good reliability. More than 95% of variation in patient satisfaction scores was attributable to patient-level variation, with less than 5% attributable to hospital-level variation. The hierarchical models explain 5 to 17% of variation at the patient level and up to 52% of variation between hospitals. Individual patient characteristics had the strongest association with all dimensions of satisfaction. Few organizational performance indicators are associated with patient satisfaction and significant determinants differ according to the satisfaction dimension.ConclusionsThe research findings highlight the importance of adjusting for both patient-level and organization-level characteristics when evaluating patient satisfaction. Better understanding and measurement of organization-level activities and processes associated with patient satisfaction could contribute to improved satisfaction ratings and care quality.
Highlights
Patient satisfaction in health care constitutes an important component of organizational performance in the hospital setting
In the US, the Centers for Medicare and Medicaid Services (CMS) has identified patient experience of care as an important determinant of the performance payments to be made to acute hospitals [8]
The most frequent admission type was through an emergency department (ED) (49.1%), followed by planned admission (40.3%)
Summary
Patient satisfaction in health care constitutes an important component of organizational performance in the hospital setting. Satisfaction measures have been developed and used to evaluate and improve hospital performance, quality of care and physician practice. Hospitals that are committed to providing excellent health care outcomes, including patient satisfaction, establish multiple programs and initiatives to achieve these goals. Measuring performance is essential to assessing the effects of continuous efforts to improve quality of care and ensuring the pursuit of excellence in hospitals [1]. In the US, the Centers for Medicare and Medicaid Services (CMS) has identified patient experience of care as an important determinant of the performance payments to be made to acute hospitals [8]. From fiscal year 2013 at least 0.3% of hospitals’ Medicare revenue (30% of the 1% withhold from participating hospitals’ Diagnosis-Related Group payments) will be determined by their performance on these experience/ satisfaction measures [9]
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