Determinants of patient satisfaction: a systematic review

Abstract

Aim:

A large number of studies have addressed the detection of patient satisfaction determinants, and the results are still inconclusive. Furthermore, it is known that contradicting evidence exists across patient satisfaction studies. This article is the second part of a two-part series of research with a goal to review a current conceptual framework of patient satisfaction for further operationalisation procedures. The aim of this work was to systematically identify and review evidence regarding determinants of patient satisfaction between 1980 and 2014, and to seek the reasons for contradicting results in relationships between determinants and patient satisfaction in the literature to design a further robust measurement system for patient satisfaction.

Method:

This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The search was conducted in PubMed, CINAHL, and Scopus in October 2014. Studies published in full in peer reviewed journals between January 1980 and August 2014 and in the English language were included. We included 109 articles for the synthesis.

Results:

We found several number of determinants of patient satisfaction investigated in a wide diversity of studies. However, study results were varied due to no globally accepted formulation of patient satisfaction and measurement system.

Conclusions:

Health care service quality indicators were the most influential determinants of patient satisfaction across the studies. Among them, health providers’ interpersonal care quality was the essential determinant of patient satisfaction. Sociodemographic characteristics were the most varied in the review. The strength and directions of associations with patient satisfaction were found inconsistent. Therefore, person-related characteristics should be considered to be the potential determinants and confounders simultaneously. The selected studies were not able to show all potential characteristics which may have had effects on satisfaction. There is a need for more studies on how cultural, behavioural, and socio-demographic differences affect patient satisfaction, using a standardised questionnaire.

Keywords

patient satisfaction determinants systematic review predictors PRISMA

Introduction

Patient satisfaction is a commonly used,¹ critical indicator in evaluation of health care service quality^2–4 as patients have contributor, target, and reformer roles in quality assurance.⁵

Results of patient satisfaction surveys allow health care providers to identify service factors that need improvement.² It also enables policy makers to understand patients’ needs and, consequently, to make strategic plan for effective and better quality services.^6,7

On the other hand, higher patient satisfaction with health care services changes patients’ behavioural intentions, such as compliance with doctor’s recommended treatment and appointments to follow-up, which results in better health outcomes^8,9 and recommendations of the service to others.¹⁰

Health services are produced not only by providers. Both providers and patients jointly engage to produce health services. As a consequence, it is not enough to measure performance of providers to evaluate health service quality. Patients’ roles and their characteristics are equally important to the performance of providers to assess quality of care.⁵

Therefore, quality improvement process on the basis of patient satisfaction necessitates to measure the associations of patient-reported experiences on specific aspects of health services, patients’ demographic variables, and personal characteristics^11,12 in order to identify parts of the services that potentially need improvements.

Although a large number of studies have addressed this topic, the results are still inconclusive and contradictory.^13–15 Furthermore, it is known that the contradicting evidence exists across patient satisfaction studies; and the generalisability and consistency of results remain uncertain.¹¹ Moreover, potential determinants of patient satisfaction differ greatly across studies^4,9,16,17 and explain little in variation of patient satisfaction.¹⁸ These weaknesses may be due to, first, a lack of consensus of theoretical framework of patient satisfaction.^8,18–22 Second, patient satisfaction is a complex and multidimensional concept with numerous determining factors;^9,16,17 however, which set of factors influence patient satisfaction the most remains debatable²³ in varying settings or conditions. Diversity of patient satisfaction conceptions leads to diverse dimensions in measurement instruments across studies^18,23 and thus diminishes the comparability of studies and benchmarking of patient satisfaction.^9,20,23

Very few systematic reviews have been done on determinants of patient satisfaction,^4,24–27 and to our knowledge, there was no systematic review conducted using a robust method and guidelines in the last decade.

It is evident that there is a need for more research on the importance of health service determinants¹¹ and patient-related characteristics²⁸ which affect shaping patient experience into patient satisfaction. Moreover, it is necessary to examine what influences the existence of inconsistent determinants and models which explain the little variation in patient satisfaction in the literature.

This article is the second part of a two-part series of research with a goal to review a current conceptual framework of patient satisfaction for further operationalisation procedures.

The aim of this work was to systematically identify and review evidence regarding determinants of patient satisfaction between 1980 and 2014, and to seek the reasons for contradicting results in relationships between determinants and patient satisfaction in the literature to design a further robust measurement system for patient satisfaction.

Methods

Design

This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.²⁹ The PRISMA statement includes 27-item checklist which assures the transparency, iteration, and complete reporting for systematic reviews.

Search strategy

The search was conducted in PubMed, CINAHL, and Scopus in October 2014. The electronic databases were searched using the below terms identified from the title, abstract, keywords, or medical subject headings: (‘predictors’ OR ‘determinants’ OR ‘factors affecting’ OR ‘measurements’ OR ‘dimensions’ OR ‘aspects’ OR ‘attributes’) AND (‘patient satisfaction’ OR ‘patient experience’ OR ‘patient priorities’ OR ‘user satisfaction’ OR ‘customer satisfaction’ OR ‘consumer satisfaction’). The search terms were adapted from the previous review studies with a similar purpose. We also manually searched reference lists of relevant articles to identify additional publications. Finally, references of all included studies were listed to eliminate the duplications and resolve proper reporting guidelines for the selected articles.

Eligibility criteria

All quantitative, qualitative, and mixed-methods studies, including experimental, quasi-experimental, observational, review, and so on were considered for the systematic review. Studies were included if they (1) evaluated overall patient satisfaction with health services; (2) assessed any association between health service determinants, patient-related variables, and patient satisfaction; (3) tested any theoretical framework related to patient satisfaction; (4) compared patient satisfaction or its determinants between particular populations or settings; and (5) conducted a literature review, systematic review, or meta-analysis on patient satisfaction determinants. Studies published in full in peer-reviewed journals between January 1980 and August 2014 and in English language were included. Other research articles that were not considered for this review include government or organisational reports, books or book chapters, conference abstracts or proceedings, dissertations, theses, commentaries, editorials, and letters. Studies of patient satisfaction with specific health facilities (mental, rehabilitation, etc.) or diseases (psychosis, cancers, transplant surgeries, etc.) were excluded except for the studies of patient satisfaction in health services in general or primary health care services. Studies involving the population age under 18, and caregivers of children were eliminated from the review.

Selection of studies

Titles and abstracts of studies in the results of searches were reviewed by two independent authors for the next stage of review. If there was a disagreement between them, the resolution was made through discussion with a third author.

Full texts of all included studies were checked against the eligibility criteria by two authors independently, and disagreements were resolved by discussions with the third author. All the eligible or potentially eligible studies were assessed by the third author once again. Studies that did not meet the eligibility criteria or those of which full texts were not found were excluded from the next stage of review.

Data extraction

Data were entered into a previously prepared data extraction sheet by two authors independently. Disagreements and missing data problems were resolved by the discussion among the three authors. Data were extracted by (1) study characteristics (author names, published year, country, and study design), (2) aim and objectives of the study, (3) sampling and data collection methods, (4) methods of assessment and analysis, and (5) key findings.

Quality assessment

Heterogeneity and variability in design of eligible studies meant that the validated design-specific quality assessment tools were inappropriate; however, each eligible study was assessed by the GRADE approach for grading the quality of evidence and the strength of recommendations. This approach was developed to improve transparency of process in developing and presenting evidence for systematic reviews and recommendations in public health and policy.^30–32 Five main quality factors of evidence were assessed: (1) risk of biases,³³ (2) inconsistency of results,³⁴ (3) indirectness of evidence,³⁵ (4) imprecision,³⁶ and (5) publication bias.³⁷ The majority of the included studies were in non-experimental design, and thus, their quality of evidence was assessed as low.³⁰ Therefore, we included as many articles as possible in the review, unless their methodology and quality were seriously flawed. Two authors assessed the quality of all included studies independently. A third author checked for completeness and precision of the assessment. Differences in the quality assessment were resolved through consensual discussion.

Data analysis

A summary of the included studies’ characteristics was described. Heterogeneity of theoretical bases, methods, measurements, and outcomes of the included studies did not allow us to employ statistical methods to combine data. Furthermore, study countries, settings, population characteristics, and data collection methods were varied. As a consequence, we did not attempt to pool the data for a meta-analysis. Therefore, the data were narratively synthesised. The studies were grouped by patient satisfaction determinants as determinants related to health service providers and predictors related to patient background characteristics. Within each group of studies, consistent and contradicting results were synthesised. Potential reasons for varying results in relationships between determinants and patient satisfaction across studies were attempted to be interpreted on the basis of the involved study characteristics.

Results

Study selection

Our initial searches identified 15,033 titles and abstracts. Some 4,018 were duplicates owing to the same articles emerged in the selected databases and a list of references of relevant articles. After elimination of the duplicates, we had 11,015 titles and abstracts for the eligibility criteria.10,729 irrelevant disease-specific, setting-specific, and questionnaire construction and validating related articles were identified during the title and abstract reviewing process with eligibility criteria application and they were removed from the list of eligible full articles. We retained 286 potentially eligible full articles and the eligibility criteria were applied to each of them. Furthermore, the GRADE approach was applied to all the full articles to check the evidence quality. We included 109 articles for the synthesis, and the remaining articles (n = 177) were excluded due to their unfitness for our purpose and inclusion criteria (under age population (age younger than 18), disease-specific and facility-specific characteristics), unclear statement of methodology and instrument, and very poor quality of evidence. Inter-rater reliability, the Kappa statistics, was 0.81. A flow diagram of study selection is shown in Figure 1.

Figure 1

Flow diagram of study selection

Among the included articles, 91 were cross-sectional, six were systematic review, four were quasi-experimental, three were meta-analysis, three were literature review, one randomised controlled trial, and one retrospective cohort studies. Table 1 (see Supplementary material note at the end of the article) shows a summary of each study included.

Risk of bias

We identified that 27 studies declared no competing interests, three declared some competing interest, and no clear declaration was found in the remaining studies.

Most of the included studies had a high risk of bias from the sources of selection bias, information bias, and confounding bias. All of the studies’ results may have been biased due to their study design, non-random sampling, inappropriate sample size, data collection methods, inappropriate data sources, systematically different non-respondents, data handling error, lack of valid instruments, confounding, inappropriate analysis methods, desirable interpretations of results, publication bias, and so on.

Our sample identified evidence for 22 determinants of patient satisfaction between 1978 and 2014. For the purpose of clarity, we grouped these determinants into two broad categories: health care provider–related determinants and patient-related characteristics.⁹

Health care provider–related determinants

Our review identified nine determinants of health care services, which may have played a role in variations in patient satisfaction: technical care, interpersonal care, physical environment, access (accessibility, availability, and finances), organisational characteristics, continuity of care, and outcome of care.

Technical care

It indicates health professionals’ competency, ability,^55,87,110 experience, and professional ethics,⁸³ including confidentiality.⁴⁰ It also refers whether the services adhere to standards and norms of clinical diagnoses and treatments.²⁶ We found 30 studies^{1,3,4,10–12,15,23,26,27,40,45,49,50,55,57,58,60,71,75,83,85,87,90,110,114,115,117,127,128} providing evidence that better technical care may have played an important role in increased patient satisfaction level. Among them, eight studies^{10,12,27,45,114,115,129} identified that perceived competency of health professionals had one of the most significant impact on the variations in patient satisfaction.

Patients who felt that they were treated incorrectly were significantly less satisfied with health services.^{11,50,60,83,87} On the other hand, better pain management,^57,100 professional management,¹⁵ and support for self-management of patient illness (the knowledge of how to monitor the illness, what diet should be taken, and what exercise should be taught by providers) were positively correlated with overall patient satisfaction.⁵⁶ However, sometimes patients were not able to evaluate technical care quality due to their limited knowledge, and thus, they may have replaced their evaluation by the perception of how health professionals were friendly and warm to them.^{1,9,13,89,90,94,111,118}

Interpersonal care

This refers to the amount of caring for patients^7,129 through noticing, participating, sharing, active listening, companioning, complimenting, comforting, hoping, forgiving, and accepting.¹²⁹

We found 62 studies^{1,3,4,10–13,15,20,23–27,38,40–42,45,48,50,51,53,56,57,58,62,66,70,71,75,80,81,83–85,87–91,94,96–99,103,104,106,108,110,115,117,121,123–125,127–129} revealing evidence that aspects of interpersonal care may have had effects on patient satisfaction. Physicians care^{4,11,50,58,97–99,103,118} and nurses care^{24,25,50,66,80,90,97–99,106,114,115,118,124} were first two of the main patient satisfaction determinants as results of the studies involved in the review. One study found that interaction of phone responding staff in health services was another important factor of patient satisfaction.⁹⁹

The physicians and nurses care were assessed by their affective behaviours: friendliness, sincerity, concerns,^55,87 sympathy, empathy,^{45,49,58,90,94,97,106,130} kindness, courtesy to patients^23,40,87 and their family or friends,⁹⁷ and respect for patient preferences.^{1,3,9,10,12,13,20,24,26,27,48,54,71,81,83,94,96,104,121,123,127,130}

Patients recommended doctors to others regarding their affective behaviours,²⁰ rather than their competency.⁸⁸ Additionally, results of two studies depicted that patients considered how their privacy were respected by health professionals when they evaluate health services.^40,41

Furthermore, providers’ communication skills and listening skills¹²⁵ were found to be positively associated with level of patient satisfaction.^{4,49,57,89,110,130} Also, doctors’ nonverbal communication skill was a crucial element of medical care and it was found to be related to patient satisfaction.^49,62,91

Additionally, patients were more likely to be satisfied with the physicians’ egalitarian role than authoritarian role. Thus, patients evaluated that physicians were competent if their physicians had egalitarian behaviour.^24,63 However, randomised, controlled trial results concluded that some training on communication skills for clinicians did not help improve patient satisfaction.⁵³

The majority of the studies recognised communication between providers and patients. However, there was another communication between provider and provider, which patients were able to assess, which affected patient satisfaction as well.⁸³

When patients were satisfied with physician care, they tended to assume physicians were credible, which in turn increased overall patient satisfaction with health services.⁹¹

The adequacy of information on illnesses,⁴⁹ treatments, tests,⁵⁰ medicines, and possible complications after discharge¹²³ by physicians^99,103,130 and nurses⁹⁰ were strongly associated with overall patient satisfaction.^{9, 12,24,40,57,71,108,124,127,130} However, a negative link between the information provided and patient satisfaction was found. In other words, the more information provided to patients, the less satisfied the patients were.⁴⁵

Another three studies provided evidence of patients’ involvement in their medical decisions improved satisfaction.^27,103,130

Physical environment

Our review identified 33 studies^{1,3,12,20,23,26,40,45,48,51,54,55,57,58,66,83,89,96–98,101,104,106,110,111,112,118,121,124,127,128} which concluded that physical environment has potential influence on patient satisfaction. The physical environment aspects that predicted to be correlated to patient satisfaction were pleasantness of the atmosphere, room comfort, bedding,^23,83 cleanliness,^{40,55,66,83,90,110,121,130} noise level,⁵⁷ temperature convenience, lighting convenience, food service,^23,40,83 bathroom comfort,¹¹¹ clarity of sign and directions, arrangement of equipment and facilities, and parking.^{1,12,20,23,48,51,54,55,58,83,89,96–98,106,118,130} In some studies, physical environment aspects were named as tangibles, which originated from SERVQUAL analysis by Parasuraman.^4,45,128 We found two studies demonstrated that more appealing hospital rooms potentially have had effects on patient evaluation⁵⁵ on most dimensions (health care personnel, food service, and housekeeping staff) of their hospital experience. Patients who were in appealing rooms evaluated physicians’ affective behaviour, physicians’ competence, and their time spending more favourably. Also, they evaluated the overall higher rating of the hospital and reported strong intentions to return to the hospital and recommend the hospital to others.¹¹² In addition, the availability of sleeping accommodation for family had a certain influence on patient satisfaction with their physical environment.⁵⁵

The purpose of the facility building presumably had an impact on patient satisfaction. If the building was purpose-built, then patient satisfaction was higher than those whose service buildings were rented.¹⁰¹

Meal quality was strongly associated with overall satisfaction in two studies.^48,124 Moreover, one study concluded that an association between meal serving temperature and satisfaction was stronger than an association between having a choice of meal and satisfaction.¹²⁴

Access

Health service access is a multidimensional determinant and it is measured by how (1) organisational issues (accessibility), (2) service resources (availability), and (3) personal barriers (affordability) prevent populations from access to health services.^130,131

We found that 35 studies^{1,4,9,12,23,24,38,41,44,45,48,50,51,55,57,58,67,68,75,78,79,86,87,90,91,94,95,97,99,103,117,125,127,128,130} provided evidence that aspects of access have affected patient satisfaction level.

Accessibility

Service accessibility was commonly measured across studies and explained by convenience of health services. We found 27 articles,^{4,9,24,40,41,44,48,50,51,55,57,67,75,78,79,86,91,95,97,99,103,117,125,127,128,130} which stated that patient satisfaction was positively associated with accessibility through aspects such as: convenient location of health services, shorter waiting time,^{40,41,48,55,67,117,127,128} fast and easy admission^55,97,130 and discharge process^57,97 and shorter time and effort to get an appointment.^9,44,78,99 Furthermore, a positive association was found between increased satisfaction and longer time spending of physicians during patient visit in four studies.^24,86,99,103 However, when patients had to wait longer in the ambulatory, especially without any notice,^50,103 they tended to be less satisfied with physician care^91,99 and the overall services.^24,95 Freedom to choose physicians or services was another important determinant of patient satisfaction in four studies.^24,51,79,125 Patients who were in health service direct access (no need to visit general practice first) countries were more satisfied with their general practitioners than those who were in countries where there were gate-keeping services.⁷⁹ Additionally, frequency of home visits of family physicians has influenced positively on patient satisfaction.⁷⁸ However, better accessibility may not have guaranteed higher satisfaction level. A study result showed that people whose immunisation coverage was high tended to be less satisfied than those whose immunisation coverage was lower.⁵¹

Availability

In our review, studies referring patient satisfaction with availability of health care services to satisfaction with sufficiency of number of physician, nurses, facilities, and equipment and identified availability was one of the main determinants of patient satisfaction.^26,45,75,117 Three studies in the review revealed evidence on nursing staff shortage was significantly negatively associated with satisfaction level, while physicians’ and nurses’ promptness of response elevated patient satisfaction.^51,90,130

Affordability

Our review identified investigations, which had evidence on affordability of service, flexibility of payment mechanisms, status of insurance, and insurance coverage comprehensiveness.^12,26 Hospital and treatment costs may have inversely influenced patient satisfaction levels;^12,117,132 however, contradictory evidence demonstrated that fee for service provided higher patient satisfaction than prepaid practice group.²⁴ Methods to pay and choices for payment arrangement were possibly important factors for patient satisfaction in health services.^24,75,130 Furthermore, results of three studies^46,56,125 depicted that patient satisfaction could have been heavily influenced by health insurance status and its coverage. Patients who had health insurance were satisfied with health services;¹²⁵ however, patients who had private insurance⁴⁶ or had some form of coverage⁵⁶ other than Medicaid⁴⁶ or managed care insurance⁷⁰ were more likely to be satisfied with health services.

Organisational characteristics

We found 26 studies^{3,23,39,45,50,61,65,66,68,69,70,73,80,84,90,94,100,103,104,108,113–115,117,126,130} that resulted in evidence of associations between health service organisation characteristics and patient satisfaction.

Reputation^114,115 and image⁷³ of the hospitals were significant determinants of patient satisfaction in Japan. Moreover, we found potential evidence that teaching and foundation trust status of hospital were positively associated with patient experiences,¹⁰⁴ and it may be due to the organisation of services,^23,117 such as patient centred care.^104,132

Administrative issues and rules and regulations of hospitals may have been associated with patient satisfaction.⁴⁵ On the other hand, bureaucracy could negatively affect patient satisfaction.³

The size and type of services had some effect on patient satisfaction.¹¹⁷ Patients were more likely to be dissatisfied if the service was dealing with bigger number of patients⁹⁴ and the size of primary practice was bigger.¹¹³

There was not much evidence whether ward type was of importance in patient satisfaction; however, two studies found out that different type of wards may have led to varying patient satisfaction. Patients who were in surgical wards were more satisfied¹⁰³ with nursing care⁶⁵ than those who were in medical wards.

Another study showed that patients’ satisfaction varied by their admission type. Patients whose admission was scheduled were more likely to be satisfied than those who were admitted as emergency.⁶⁹

Satisfaction level of physicians^61,70 and nurses with their job and facilities^39,90,113 was associated with satisfaction level of patients. Physicians who were working full-time had lower satisfaction with their work than those who were working part-time.⁷⁰ Furthermore, higher job satisfaction of non-physicians had more positive effect on patient satisfaction³⁹ than job satisfaction of physician.¹¹³

Patients were more satisfied with nursing care, doctor care, information provided, coordination of care,²³ and outcomes of the hospital stay, when nurses felt that their job was more meaningful. Nurses’ shortage, burnout, overwork,^39,66,80 exhaustion and frequently expressed intention to quit,⁸⁴ higher turnover,¹⁰⁸ and worse working environment³⁹ were all associated with lower patient satisfaction.⁸⁴ On the contrary, motivated and supported nurses demonstrated improved effort towards their work and in turn increased performance, which is directly correlated to increased patient satisfaction.^39,68

On the other hand, two studies had evidence that good nurse and physician collaborations⁸⁰ and relationships³⁹ were significantly related to higher patient satisfaction.

Some studies provided evidence that socio-demographic factors of doctors,¹¹⁷ such as sex,^85,126 had a potential effect on patient satisfaction. Owing to the cultural background, patients believed that male physicians were more competent than females, while female physicians were more empathetic.¹²⁶

Continuity

In our sample, eight studies measured a relationship between health service continuity and patient satisfaction. Continuity of health care service refers to uninterruptedness of health service process from the same hospital, location, or provider²⁶ and in which ‘patient and the physician are cooperatively involved in ongoing health care management toward the goal of high quality, cost-effective medical care’.¹³² It might have been positively related to patient satisfaction,^{26,117,121,130} and thus, two studies concluded that self-reported continuity of care was one of the most frequently measured determinants³ of overall patient satisfaction or some aspects of satisfaction.⁶⁴

Three studies in our sample concluded that continuity of care in relationship of physician and patient had significantly positive effect on patient satisfaction,^109,121 specifically among the older patients.³⁸

Efficacy/outcome of care

It measures how helpful the care was to improve the health status or health condition.²⁶ The treatment outcome was among the main indicators of patient satisfaction in four studies.^4,23,26,130 Patients’ perceived health improvement had positive impact on their satisfaction.⁴⁴ And patients who experienced complications after discharge reported lower satisfaction.²³ Furthermore, patients considered a mortality rate when they chose health services. However, input and process indicators were more important than the outcome indicators to choose health services.¹¹⁷

Patient-related characteristics

We identified a total of 71 studies that revealed evidence of relationships between any of 13 demographic and psychological (age, gender, education, socio-economic status, marital status, race, religion, geographic characteristics, visit regularity, length of stay, health status, personality, and expectations) characteristics of patients and overall satisfaction with health services. Findings of relationships between patient-related characteristics and patient satisfaction were weak, widely inconsistent, and contradictory across the sample.

Age

Our sample had 36 studies^{9, 11,14,15,20,23–25, 28,43,44,48,51,54,56,59,60,65,67,70,73,75,77,78, 81,94,98,102,103,105,114–116} that had evidence that patients’ age had effect on their satisfaction.

Age was the most important and consistent⁹ determining variable of patient satisfaction among the background variables.^{20,67,73,94,105} Some eight studies provided evidence on significantly strong age effect on patient satisfaction^{28,43,59,60,64,67} particularly with organisational aspects at the clinic¹¹ and among Caucasian and African American patients.⁹⁸

Majority of the studies concluded that older patients were more satisfied with health services than younger ones^{9,13,20,23,24,28,43,44,51,54,56,59,60,64,70,73,78,81,94,98,102,103,114,125,129} in primary care⁴⁸ or among a group that prefers interpersonal care¹¹⁵ and nursing care.⁶⁵ However, in the former Soviet Union countries, younger populations were more likely to be satisfied.¹⁴ A relationship between age and satisfaction probably was in non-linear pattern, as patient satisfaction increased with age until 80 years and decreased steeply.^25,77 Another study showed evidence that the oldest and the youngest age group were more satisfied with physician conduct and less satisfied with accessibility.⁷⁵

Gender

We identified 15 articles^{9,26,48,54,56,60,65,73,75,85,101,102,110,120,126} which had evidence of correlations between gender and satisfaction with health services. Women were more satisfied with health services than men in seven studies.^{26,48,54,56,75,85,101} On the contrary, six studies concluded that men had higher satisfaction scores^{60,73,102,110} on nursing care,⁶⁵ comfort, visiting, and cleanliness¹⁰² than women. Results of relationship between gender and patient satisfaction were greatly differing across the studies⁹ and no clear pattern of satisfaction with commercial health plans between male and female enrollees found.¹²⁰ Additionally, results of a study suggested that patients preferred physicians of the same gender in general.¹²⁶

Education

Education level was inversely associated with satisfaction level^{9,50,51,56,60,73,100,102,103,107,133} of nursing care.⁶⁵ Moreover, literate patients were more satisfied with the primary health care services than those who were illiterate.¹⁰¹

However, these facts were inconsistent with the results of some other studies which stated that those who were less educated tended to be less satisfied.^26,69,81,125 A quasi-experimental study learnt that patient satisfaction was not improved by education improvement.⁹⁵

Socio-economic status

In our sample, 13 studies yielded evidence on socio-economic status–related determinants and patient satisfaction. Socio-economic status was positively correlated with patient satisfaction in three studies,^14,93,133 despite one study indicating that the relationship was inverse.¹⁰⁴ No clear trend was found in two review studies.^9,26 Furthermore, the higher gross domestic product influenced higher patient satisfaction at country level.⁵¹

Among the socio-economic variables, income was the only variable which had much impact on satisfaction,⁹² but bidirectional. Higher income group patients tended to be more satisfied with overall health services^46,125,133 or with access and technical quality.²⁶ Another study concluded that patients who had lower income were more satisfied with nursing care.⁶⁵

Furthermore, patients’ housing quality was positively associated with their satisfaction with primary health care.⁴⁴ In regard to working status, it was evident that manual workers were less satisfied with the communication of health staff.⁵⁹

Marital status

Evidence was contradictory and unclear.²⁶ Two studies stated married patients were more satisfied with health services,^28,125 whereas another study showed single or divorced patients were more satisfied on some aspects, such as comfort, visiting, and cleanliness.¹⁰²

Race

The relationships between race and satisfaction were not clear.²⁶ Ethnic minority groups (non-White) were less satisfied than the majority (White).^{9, 24,70,75,93,104} Patients who were born where they lived (Sweden)⁸¹ or natives (Kuwaitis)⁷ and whose mother tongue was as the native language of where they lived (Dutch in The Netherlands)⁷³ were more satisfied with health services. Furthermore, patients were satisfied when their physicians were of same race or ethnicity as themselves. Race concordance made patients to trust physicians of their own race and to feel more comfortable. On the other hand, it was found that different race physicians treated patients with less courtesy or discrimination.⁸² Two more studies learnt that racism, discrimination, and health professionals’ attitude of ethnicity had strongly significant effect on patient satisfaction.^46,47 This association may be mediated by cultural mistrust and trust in providers.⁴⁷ Although it was evident that the way majority and minority populations evaluate their health services was different,⁹⁸ unequal qualities in some aspects for racial differences were not correlated with satisfaction.⁷²

Religion

There was a little evidence of whether religion affected overall patient satisfaction. One study concluded that patients reported a higher level of satisfaction when they had discussions about their religious and spiritual concerns during their inpatient stay.¹²² There was an unavoidable need for patients to engage physicians and health professionals in discussions about their religious or spiritual issues. However, health professionals did not pay enough attention to patients’ religious or spiritual concerns.¹²²

Geographic characteristics

Geographic region^61,125 and residence area⁴⁴ were potentially important determinants of overall patient satisfaction. Rural populations were more likely to be satisfied than urban populations.^44,133 In addition, country of residence was associated with overall patient satisfaction. Population of Ukraine was more likely to report higher satisfaction with their health system than the population of Russia.¹⁴

Visit regularity

Regularity of patients to primary health care may have been a determinant of patient satisfaction.^78,101 The more often patients visited the centre, the more they were satisfied with the services.¹⁰¹

Length of stay

Length of stay in hospital was probably a determinant of patient satisfaction. However, there was no clear pattern.⁵² There were studies that found a relationship between longer length of stay and lower patient satisfaction^94,107,114 with environment aspects.¹⁰² Conversely, we found evidence that patients who stayed longer were satisfied more than those who stayed a shorter length of time.⁶⁵

Health status

Self-assessed health status was one of the strongest predictors of patient satisfaction.⁷³ It was evident that poor health status led to overall lower satisfaction levels^{13,23,24,60,70,73,75,103,105,125,129,133} with interpersonal care and organisational characteristics.⁶⁴ Self-assessed health was positively correlated to patient satisfaction in 10 articles.^{7,11,25,42,43,45,51,77,81,125} Patients who were experiencing pain^25,59,69 and suffering from severe symptoms⁷⁶ and illnesses¹⁰⁰ reported lower satisfaction with the health services. Furthermore, long-term limiting illnesses,¹¹⁶ having more than one chronic illness, being obese and⁵⁶ disabled,^25,129,133 and having lower quality of life^24,129 were potential factors for lower satisfaction.

On the other hand, we found evidence that mental health status was significantly associated with overall patient satisfaction. Absence of mental illnesses or disorders^59,69,76,78 or recovery of anxiety, distress, and depression^{9,15,24,42,105,114,115,133} may have been strong determinants of patient satisfaction. In addition, a small amount of evidence was found that patient sense of coherence score possibly played a role in the variations of patient satisfaction.⁶⁹

Personality

We identified that only one study concluded that patient’s personality may have affected patient satisfaction positively.⁵¹ However, another study found no clear evidence of a correlation between patient personality and satisfaction.⁷⁴ Nevertheless, there was a relationship between positive emotions and higher patient satisfaction.^118,119,128 Also, patients who were emotionally stable tended to report higher satisfaction with health services.⁸¹ Furthermore, the more the patients believed themselves that they had strength and capability to reach their goal or complete tasks, the more they were satisfied.⁹¹

Expectations

Expectations were studied very frequently as one of the most important predictors of patient satisfaction.^9,43,50,103 When patients’ expectations matched health service performance, patients were satisfied with overall health services.^1,13,44 However, associations between expectations and satisfaction were inconsistent across the studies; and methods and interpretations in the studies varied. Furthermore, expectation-based theories and models were not supported by empirical studies.²⁴

Discussion

Our review found that the potential determinants playing important roles in patient satisfaction varied across studies as it was suggested in the literature.^24,48 However, the strongest determinants of patient satisfaction across studies were perceptions of health service quality characteristics. More specifically, quality of health care providers’ interpersonal skills, competence, physical environment of the facility, accessibility, continuity of care, hospital characteristics, and outcome of care are all associated with patient satisfaction positively and strongly in order. This result supports a number of theories and models on the health service quality, suggesting that health service quality indicators^{24,127,133,134} or health service input, process, and outcome indicators play crucial roles in patient satisfaction. Among the service-related determinants, strongest positive association between health professionals’ interpersonal skills and patient satisfaction was found in majority of the studies. The previous systematic reviews with the same purpose concluded similarly.^15,23,24,60 Therefore, first, it may be necessary to attempt to formulate patient satisfaction based on the health service quality indicators and how the patients develop their satisfaction with health services rather than single-concept expectations.¹³⁴ Second, if patient satisfaction is a central issue of the health services, a first step would be establishing or strengthening the training of interpersonal skills to increase communication and empathetic skills of medical students and to ensure the continuity of the training at the workplace for health professionals.¹³⁵ Third, persistent evaluation of health professionals’ competence and interpersonal skills is essential to prioritise resources, so that patient satisfaction can increase efficiently by training and incentives for health professionals.²⁴

The relationships between person-related characteristics and satisfaction were the most contradictory in this study. This result supports the results of the previous studies and systematic reviews on determinants of patient satisfaction.^24,102 However, there is evidence that socio-demographic factors of patients affect the satisfaction with health services. Yet, the contradictory effects of the socio-demographic variables may show that these variables should be taken into account when comparing patient satisfaction between specific groups or countries^24,116 due to their potential moderating and mediating effects on the associations between health service quality indicators and patient satisfaction.^4,24

On the other hand, heterogeneity of theoretical framework, study design, and measurements may have had responsibility for the inconsistency and incomparability of results. In addition, we reviewed a wide range of different studies from different departments, settings, and countries. Thus, varied types and geographic locations of health facilities were the potential sources of inconsistency^{44,51,87,97,99,111,130} in the review due to the cultural differences.^41,101,108 Hence, a crude satisfaction score is not recommended for the comparison of patient satisfaction results. There is no such ‘typical patient’, and individuals are different regarding background characteristics.^{9,25,45,47,73,93,94,98,130,136} Thus, patient personal characteristics played significantly important role in varying results. However, in our sample, some studies did not consider patient individual characteristics for adjustment. In addition, although there were many other individual characteristics that should have been taken into account, we found that not much attention was paid to those factors. We identified surprisingly little evidence for influence of patient culture,⁴⁵ illness behaviour,⁸⁵ beliefs,^63,98 attitudes, and value⁵⁸ on patient satisfaction. Moreover, health sector resource constraints, service provider attitudes and quality for specific groups of the population, health insurance coverage, informal payment, political situation, patients’ expectations, trust towards health service, and trust towards government may intervene the evaluation of patient satisfaction.^14,15 Thus, cross-cultural or cross-country studies should interpret their results cautiously.¹⁵

Furthermore, the categorisations of service determinants of patient satisfaction in the measurements varied among the studies. Items of determinants were not always the same across studies.¹⁰⁸

The majority of studies in our sample were observational in nature and descriptive design. A lack of control groups or adjustment for confounding factors may have caused difficulties in detecting intrinsic determinants, and causal relationships between determinants and patient satisfaction. We identified very few studies with an acceptable study design to find causal relationships between determinants and patient satisfaction in any setting and geographic location. There were 7 out of 89 studies designed to provide quantitative evidence that certain determinants had causal effects on increased patient satisfaction.^{68,73,74,81,91,118,119}

There were many other reasons that the selected studies significantly varied. For instance, time lag of satisfaction survey has potentially played a role in variation in patient satisfaction determinants and results.^13,136 Jackson, Chamberlin, and Kroenke stated that patient satisfaction varied as difference of time points of patient survey.¹³ Additionally, seasonal difference of patient satisfaction survey probably influenced patient satisfaction results by patients’ unwillingness of patients to visit hospitals during summer time, and a fewer health professionals during this time.¹⁰⁸ Studies conducted patient satisfaction survey in a wide range of points in time during hospital visit, stay, or discharge. Furthermore, the effect of length of stay may have caused a variation in results. Factors that shape patient experiences into satisfaction were significantly different among those hospitalised less than one week, between one week and a month, and more than a month in regards to their illness severity, health improvement, and psychological wellness.¹¹⁴ The place where the survey was conducted was an important indicator of deviated satisfaction results as well. Some studies held a survey on site and this potentially introduced social desirability biases to the results. Another possible source of inconsistent results of patient satisfaction was related to who responded to the questionnaire. If someone who was not a patient responded to the survey for patients, the results showed a lower satisfaction level and deviated determinants of importance than when patients responded themselves.^54,102

Majority of the measuring instruments were not well validated in this study and there is a need for a ‘gold’ standard instrument that can be adaptable to different countries, cultures, and preferences.¹³⁷

According to the results, selected studies were widely different and the concept, patient satisfaction, itself is heterogeneous in nature. A generalisation of results from the specific studies to a nationwide or cross-national picture does not seem to be the best trend for detecting the most influential person-related determinants of patient satisfaction for further improvement of the conceptualisation, unless the presence of reference instrument is adaptable to other languages and sociocultural contexts.^24,137 Furthermore, socioeconomic-related inequality in health and health care utilisations have been extensively documented,^138,139 although, the need to study socioeconomic-related inequality in patient satisfaction is great.

Limitations

Our study had several limitations. First, we did not include foreign language articles, which may have introduced bias against our objective–to review patient satisfaction determinants internationally–and precluded from including socio-economic and culture-specific evidence. Second, we did not include specific terms for socio-demographic and psychological wellness with patient satisfaction. Therefore, we may have missed studies that addressed population-specific satisfaction. On the other hand, we used broad inclusion and exclusion criteria to gather as many studies as possible; however, this attempt led us to have a huge amount of data to extract and synthesise. Thus, there may have been potential unidentified or under-interpreted specific constructs in the review.

Conclusion

In this review, studies published on patient satisfaction and its determinants between 1980 and 2014 were reviewed based on the three online databases. We found several determinants of patient satisfaction investigated in a wide diversity of studies, including fields of marketing, behavioural science, psychology, health management, and so on. Nonetheless, study results between and within fields were varied, owing to no globally accepted formulation of patient satisfaction.

However, health service quality indicators have strong and positive influences on patient satisfaction across the studies. Among the service indicators, interpersonal care was the most consistent and strongest determinant of patient satisfaction.

There is evidence that socio-demographic factors of patients affect their satisfaction with health services. However, the strength and direction of the effects on patient satisfaction were varied. These varied effects may demonstrate that the socio-demographic factors do not only affect patient satisfaction, they may play a moderating and mediating roles in the associations between health service determinants and patient satisfaction. In this sense, person-related variables should be considered both potential predictors of patient satisfaction and confounders in the same study to control their roles in the true associations between determinants and patient satisfaction.

In general, studies found very high or higher satisfaction levels. Higher reported satisfaction does not necessarily mean that the performances of all the determinants were satisfactory,²⁰ and it requires improvement in the measurement system. Measuring dissatisfaction and sources of dissatisfaction of health services⁸³ would possibly reduce widely known high level of satisfaction and give a more practical picture.

The diversity of conceptual definition of patient satisfaction resulted in diverse and insufficient measurements. Also, some measures could not capture all experiences of patients with health services. Therefore, it is suggested that employing population-specific or setting-specific and valid instruments with open questions for comments and complaints from patients would reduce the weakness. Furthermore, a great proportion of studies were cross-sectional and descriptive, and the results precluded from estimating causal relationships between determinants and satisfaction. Thus, there is a need to employ longitudinal or experimental study design to detect true causal relationships.

Furthermore, the selected studies were not able to show all potential characteristics which may have effects on satisfaction. There is a need for more studies on how cultural, behavioural, and socio-economic differences affect patient satisfaction with standardised questionnaire which is adaptable to specific groups and countries for further comparisons.

Supplemental Material

sj-pdf-1-rsh-10.1177_1757913916634136 – Supplemental material for Determinants of patient satisfaction: a systematic review

Supplemental material, sj-pdf-1-rsh-10.1177_1757913916634136 for Determinants of patient satisfaction: a systematic review by Enkhjargal Batbaatar, Javkhlanbayar Dorjdagva, Ariunbat Luvsannyam, Matteo Mario Savino and Pietro Amenta in Perspectives in Public Health

Footnotes

Supplemental Material

Table 1 is available at

Funding

This research received a grant from the Sustainable E-Tourism Programme, Erasmus Mundus Action 2 – Strand 1 with a grant agreement number 2010-2359/001-001-EMA2.

References

Andaleeb

SS.

Service quality perceptions and patient satisfaction: A study of hospitals in a developing country. Social Science & Medicine 2001; 52: 1359–70.

Aharony

Strasser

Patient satisfaction: What we know about and what we still need to explore. Medical Care Review 1993; 50: 49–79.

Hall

Dornan

MC.

What patients like about their medical care and how often they are asked: A meta-analysis of the satisfaction literature. Social Science & Medicine 1988; 27: 935–9.

Naidu

Factors affecting patient satisfaction and healthcare quality. International Journal of Health Care Quality Assurance 2009; 22: 366–81.

Donabedian

The Lichfield Lecture. Quality assurance in health care: Consumers’ role. Quality in Health Care 1992; 1: 247–51.

Al-Abri

Al-Balushi

Patient satisfaction survey as a tool towards quality improvement. Oman Medical Journal 2014; 29: 3–7.

Alhashem

Alquraini

Chowdhury

RI.

Factors influencing patient satisfaction in primary healthcare clinics in Kuwait. International Journal of Health Care Quality Assurance 2011; 24: 249–62.

Pascoe

GC.

Patient satisfaction in primary health care: A literature review and analysis. Evaluation and Program Planning 1983; 6: 185–210.

Sitzia

Wood

Patient satisfaction: A review of issues and concepts. Social Science & Medicine 1997; 45: 1829–43.

10.

Cheng

Yang

Chiang

TL.

Patient satisfaction with and recommendation of a hospital: Effects of interpersonal and technical aspects of hospital care. International Journal for Quality in Health Care 2003; 15: 345–55.

11.

Danielsen

Bjertnaes

Garratt

Forland

Iversen

Hunskaar

The association between demographic factors, user reported experiences and user satisfaction: Results from three casualty clinics in Norway. BMC Family Practice 2010; 11: 73.

12.

Andaleeb

SS.

Determinants of customer satisfaction with hospitals: A managerial model. International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services 1998; 11: 181–7.

13.

Jackson

Chamberlin

Kroenke

Predictors of patient satisfaction. Social Science & Medicine 2001; 52: 609–20.

14.

Footman

Roberts

Mills

Richardson

McKee

Public satisfaction as a measure of health system performance: A study of nine countries in the former Soviet Union. Health Policy 2013; 112: 62–9.

15.

Sanchez-Piedra

Prado-Galbarro

Garcia-Perez

Santamera

AS.

Factors associated with patient satisfaction with primary care in Europe: Results from the EUprimecare project. Quality in Primary Care 2014; 22: 147–55.

16.

Gill

White

A critical review of patient satisfaction. Leadership in Health Services 2009; 22: 8–19.

17.

Rosenthal

Shannon

SE.

The use of patient perceptions in the evaluation of health-care delivery systems. Medical Care 1997; 35: NS58–68.

18.

Vranceanu

Ring

Factors associated with patient satisfaction. Journal of Hand Surgery 2011; 36: 1504–8.

19.

Fitzpatrick

Hopkins

Problems in the conceptual framework of patient satisfaction research: An empirical exploration. Sociology in Health & Illness 1983; 5: 297–311.

20.

Jenkinson

Coulter

Bruster

Richards

Chandola

Patients’ experiences and satisfaction with health care: Results of a questionnaire study of specific aspects of care. Quality & Safety in Health Care 2002; 11: 335–9.

21.

Sixma

Kerssens

Campen

Peters

Quality of care from the patients’ perspective: From theoretical concept to a new measuring instrument. Health Expectations 1998; 1: 82–95.

22.

Williams

Patient satisfaction: A valid concept?

Social Science & Medicine 1994; 38: 509–16.

23.

Schoenfelder

Klewer

Kugler

Determinants of patient satisfaction: A study among 39 hospitals in an in-patient setting in Germany. International Journal for Quality in Health Care 2011; 23: 503–9.

24.

Crow

Gage

Hampson

Hart

Kimber

Storey

, et al. The measurement of satisfaction with healthcare: Implications for practice from a systematic review of the literature. Health Technology Assessment 2002; 6: 1–244.

25.

Scotti

DJ.

Satisfaction with medical care among elderly patients: A review of research findings with implications for management practice and future inquiry. Journal of Hospital Marketing & Public Relations 2005; 15: 3–32.

26.

Ware

Jr Davies-Avery

Stewart

AL.

The measurement and meaning of patient satisfaction. Health & Medical Care Services Review 1978; 1: 1, 3–15.

27.

Wensing

Jung

Mainz

Olesen

Grol

A systematic review of the literature on patient priorities for general practice care. Part 1: Description of the research domain. Social Science & Medicine 1998; 47: 1573–88.

28.

Hall

Dornan

MC.

Patient sociodemographic characteristics as predictors of satisfaction with medical care: A meta-analysis. Social Science & Medicine 1990; 30: 811–8.

29.

Liberati

Altman

Tetzlaff

Mulrow

Gøtzsche

Ioannidis

, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Journal of Clinical Epidemiology 2009; 62: e1–34.

30.

Schünemann

Broz͘ek

Guyatt

Oxman

. GRADE handbook for grading quality of evidence and strength of recommendations. The GRADE Working Group, 2013. Available at:http://gdt.guidelinedevelopment.org/central_prod/_design/client/handbook/handbook.html

31.

Guyatt

Oxman

Schünemann

Tugwell

Knottnerus

GRADE guidelines: A new series of articles in the Journal of Clinical Epidemiology. Journal of Clinical Epidemiology 2011; 64: 380–2.

32.

Balshem

Helfand

Schünemann

Oxman

Kunz

Broz͘ek

, et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology 2011; 64: 401–6.

33.

Guyatt

Oxman

Vist

Kunz

Broz͘ek

Alonso-Coello

, et al. GRADE guidelines: 4. Rating the quality of evidence – Study limitations (risk of bias). Journal of Clinical Epidemiology 2011; 64: 407–15.

34.

Guyatt

Oxman

Kunz

Woodcock

Broz͘ek

Helfand

, et al. GRADE guidelines: 7. Rating the quality of evidence–inconsistency. Journal of Clinical Epidemiology 2011; 64: 1294–302.

35.

Guyatt

Oxman

Kunz

Woodcock

Broz͘ek

Helfand

, et al. GRADE guidelines: 8. Rating the quality of evidence – Indirectness. Journal of Clinical Epidemiology 2011; 64: 1303–10.

36.

Guyatt

Oxman

Kunz

Broz͘ek

Alonso-Coello

Rind

, et al. GRADE guidelines 6. Rating the quality of evidence – Imprecision. Journal of Clinical Epidemiology 2011; 64: 1283–93.

37.

Guyatt

Oxman

Montori

Vist

Kunz

Broz͘ek

, et al. GRADE guidelines: 5. Rating the quality of evidence – Publication bias. Journal of Clinical Epidemiology 2011; 64: 1277–82.

38.

Adler

Vasiliadis

Bickell

The relationship between continuity and patient satisfaction: A systematic review. Family Practice 2010; 27: 171–8.

39.

Aiken

Sermeus

Van den Heede

Sloane

Busse

McKee

, et al. Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ 2012; 344: e1717.

40.

Akyüz

Ayyildiz

A structural equation model test of patient satisfaction in the health service organizations in Trabzon City. International Journal of Economic and Administrative Studies 2012; 4: 47–65.

41.

Mendoza Aldana

Piechulek

al-Sabir

. Client satisfaction and quality of health care in rural Bangladesh. Bulletin of the World Health Organization 2001; 79: 512–7.

42.

al-Mandhari

Hassan

Haran

Association between perceived health status and satisfaction with quality of care: Evidence from users of primary health care in Oman. Family Practice 2004; 21: 519–27.

43.

Al-Windi

Predictors of satisfaction with health care: A primary healthcare-based study. Quality in Primary Care 2005; 13: 67–74.

44.

Atkinson

Haran

Individual and district scale determinants of users’ satisfaction with primary health care in developing countries. Social Science & Medicine 2005; 60: 501–13.

45.

Badri

Attia

Ustadi

AM.

Healthcare quality and moderators of patient satisfaction: Testing for causality. International Journal of Health Care Quality Assurance 2009; 22: 382–410.

46.

Becker

Newsom

Socioeconomic status and dissatisfaction with health care among chronically ill African Americans. American Journal of Public Health 2003; 93: 742–8.

47.

Benkert

Peters

Clark

Keves-Foster

Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care. Journal of the National Medical Association 2006; 98: 1532–40.

48.

Bikker

Thompson

AG.

Predicting and comparing patient satisfaction in four different modes of health care across a nation. Social Science & Medicine 2006; 63: 1671–83.

49.

Birhanu

Assefa

Woldie

Morankar

Determinants of satisfaction with health care provider interactions at health centres in central Ethiopia: A cross sectional study. BMC Health Services Research 2010; 10: 78.

50.

Bjertnaes

Sjetne

Iversen

HH.

Overall patient satisfaction with hospitals: Effects of patient-reported experiences and fulfilment of expectations. BMJ Quality & Safety 2012; 21: 39–46.

51.

Bleich

Ozaltin

Murray

CK.

How does satisfaction with the health-care system relate to patient experience?

Bulletin of the World Health Organization 2009; 87: 271–8.

52.

Borghans

Kleefstra

Kool

Westert

GP.

Is the length of stay in hospital correlated with patient satisfaction?

International Journal for Quality in Health Care 2012; 24: 443–51.

53.

Brown

Boles

Mullooly

Levinson

Effect of clinician communication skills training on patient satisfaction. A randomized, controlled trial. Annals of Internal Medicine 1999; 131: 822–9.

54.

Butler

Oswald

Turner

DE.

The effects of demographics on determinants of perceived health-care service quality. The case of users and observers. Journal of Management in Medicine 1996; 10: 8–20.

55.

Hatice

Camgöz-Akdağ

Zineldin

Quality of health care and patient satisfaction. Clinical Governance: An International Journal 2010; 15: 92–101.

56.

Carlin

Christianson

Keenan

Finch

Chronic illness and patient satisfaction. Health Services Research 2012; 47: 2250–72.

57.

Chen

Birkmeyer

Saint

Jha

AK.

Hospitalist staffing and patient satisfaction in the national Medicare population. Journal of Hospital Medicine 2013; 8: 126–31.

58.

Choi

Cho

Lee

Kim

The relationships among quality, value, satisfaction and behavioral intention in health care provider choice: A South Korean study. Journal of Business Research 2004; 57: 913–21.

59.

Cohen

Age and health status in a patient satisfaction survey. Social Science & Medicine 1996; 42: 1085–93.

60.

Danielsen

Garratt

Bjertnaes

Pettersen

KI.

Patient experiences in relation to respondent and health service delivery characteristics: A survey of 26,938 patients attending 62 hospitals throughout Norway. Scandinavian Journal of Public Health 2007; 35: 70–7.

61.

DeVoe

Fryer

Jr Straub

McCann

Fairbrother

Congruent satisfaction: Is there geographic correlation between patient and physician satisfaction?

Medical Care 2007; 45: 88–94.

62.

DiMatteo

Hays

Prince

LM.

Relationship of physicians’ nonverbal communication skill to patient satisfaction, appointment noncompliance, and physician workload. Health Psychology 1986; 5: 581–94.

63.

Ditto

Moore

Hilton

Kalish

JA.

Beliefs about physicians: Their role in health care utilization, satisfaction, and compliance. Basic and Applied Social Psychology 1995; 17: 23–48.

64.

Fan

Burman

McDonell

Fihn

SD.

Continuity of care and other determinants of patient satisfaction with primary care. Journal of General Internal Medicine 2005; 20: 226–33.

65.

Findik

Unsar

Sut

Patient satisfaction with nursing care and its relationship with patient characteristics. Nursing & Health Sciences 2010; 12: 162–9.

66.

Gotlieb

JB.

Understanding the effects of nurses on the process by which patients develop hospital satisfaction. Holistic Nursing Practice 2002; 16: 49–60.

67.

Green

Davis

Toward a predictive model of patient satisfaction with nurse practitioner care. Journal of the American Academy of Nurse Practitioners 2005; 17: 139–48.

68.

Greenslade

Jimmieson

NL.

Organizational factors impacting on patient satisfaction: A cross sectional examination of service climate and linkages to nurses’ effort and performance. International Journal of Nursing Studies 2011; 48: 1188–98.

69.

Grondahl

Hall-Lord

Karlsson

Appelgren

Wilde-Larsson

Exploring patient satisfaction predictors in relation to a theoretical model. International Journal of Health Care Quality Assurance 2013; 26: 37–54.

70.

Haas

Cook

Puopolo

Burstin

Cleary

Brennan

TA.

Is the professional satisfaction of general internists associated with patient satisfaction?

Journal of General Internal Medicine 2000; 15: 122–8.

71.

Hall

Dornan

MC.

Meta-analysis of satisfaction with medical care: Description of research domain and analysis of overall satisfaction levels. Social Science & Medicine 1988; 27: 637–44.

72.

Harris-Haywood

Sylvia-Bobiak

Stange

Flocke

SA.

The association of how time is spent during outpatient visits and patient satisfaction: Are there racial differences?

Journal of the National Medical Association 2007; 99: 1061–5.

73.

Hekkert

Cihangir

Kleefstra

van den Berg

Kool

RB.

Patient satisfaction revisited: A multilevel approach. Social Science & Medicine 2009; 69: 68–75.

74.

Hendriks

Smets

Vrielink

Van Es

De Haes

JC.

Is personality a determinant of patient satisfaction with hospital care?

International Journal for Quality in Health Care 2006; 18: 152–8.

75.

Hsieh

Kagle

JD.

Understanding patient satisfaction and dissatisfaction with health care. Health & Social Work 1991; 16: 281–90.

76.

Jackson

Kroenke

Difficult patient encounters in the ambulatory clinic: Clinical predictors and outcomes. Archives of Internal Medicine 1999; 159: 1069–75.

77.

Jaipaul

Rosenthal

GE.

Are older patients more satisfied with hospital care than younger patients?

Journal of General Internal Medicine 2003; 18: 23–30.

78.

Kersnik

Determinants of customer satisfaction with the health care system, with the possibility to choose a personal physician and with a family doctor in a transition country. Health Policy 2001; 57: 155–64.

79.

Kroneman

Maarse

van der Zee

Direct access in primary care and patient satisfaction: A European study. Health Policy 2006; 76: 72–9.

80.

Larrabee

Ostrow

Withrow

Janney

Hobbs

Jr Burant

Predictors of patient satisfaction with inpatient hospital nursing care. Res Nurs Health 2004; 27: 254–68.

81.

Larsson

Wilde-Larsson

Quality of care and patient satisfaction: A new theoretical and methodological approach. International Journal of Health Care Quality Assurance 2010; 23: 228–47.

82.

Laveist

Nuru-Jeter

Is doctor-patient race concordance associated with greater satisfaction with care?

Journal of Health and Social Behavior 2002; 43: 296–306.

83.

Lee

Moriarty

Borgstrom

Horwitz

LI.

What can we learn from patient dissatisfaction? An analysis of dissatisfying events at an academic medical center. Journal of Hospital Medicine 2010; 5: 514–20.

84.

Leiter

Harvie

Frizzell

The correspondence of patient satisfaction and nurse burnout. Social Science & Medicine 1998; 47: 1611–7.

85.

Zyzanski

SJ.

Patient satisfaction with the clinical encounter: Social psychological determinants. Social Science & Medicine 1987; 24: 351–7.

86.

Lin

Albertson

Schilling

Cyran

Anderson

Ware

, et al. Is patients’ perception of time spent with the physician a determinant of ambulatory patient satisfaction? Archives of Internal Medicine 2001; 161: 1437–42.

87.

Lin

YK.

Patient satisfaction evaluations in different clinic care models: Care stratification under a national demonstration project. Health Place 2010; 16: 85–92.

88.

Lovdal

Pearson

Wanted – Doctors who care. Journal of Health Care Marketing 1989; 9: 37–41.

89.

Marcinowicz

Chlabicz

Grebowski

Patient satisfaction with healthcare provided by family doctors: Primary dimensions and an attempt at typology. BMC Health Services Research 2009; 9: 63.

90.

Merkouris

Papathanassoglou

Lemonidou

Evaluation of patient satisfaction with nursing care: Quantitative or qualitative approach?

International Journal of Nursing Studies 2004; 41: 355–67.

91.

Moore

Wright

Bernard

DR.

Influences on health delivery system satisfaction: A partial test of the ecological model. Health Communication 2009; 24: 285–94.

92.

Mummalaneni

Gopalakrishna

Mediators

vs.

moderators of patient satisfaction. Journal of Health Care Marketing 1995; 15: 16–22.

93.

Myburgh

Solanki

Smith

Lalloo

Patient satisfaction with health care providers in South Africa: The influences of race and socioeconomic status. International Journal for Quality in Health Care 2005; 17: 473–7.

94.

Nguyen Thi

Briancon

Empereur

Guillemin

Factors determining inpatient satisfaction with care. Social Science & Medicine 2002; 54: 493–504.

95.

Oermann

Masserang

Maxey

Lange

MP.

Clinic visit and waiting: Patient education and satisfaction. Nursing Economist 2002; 11: 247–50.

96.

Oswald

Turner

Snipes

Butler

Quality determinants and hospital satisfaction. Perceptions of the facility and staff might be key influencing factors. Marketing Health Services 1998; 18: 18–22.

97.

Otani

Kurz

RS.

The impact of nursing care and other healthcare attributes on hospitalized patient satisfaction and behavioral intentions. Journal of Healthcare Management 2004; 49: 181–96; discussion 196–7.

98.

Otani

Herrmann

Kurz

RS.

Patient satisfaction integration process: Are there any racial differences?

Health Care Management Review 2010; 35: 116–23.

99.

Otani

Kurz

Harris

LE.

Managing primary care using patient satisfaction measures. Journal of Healthcare Management 2005; 50: 311–24; discussion 324–5.

100.

Koné Péfoyo

Wodchis

WP.

Organizational performance impacting patient satisfaction in Ontario hospitals: A multilevel analysis. BMC Research Notes 2013; 6: 509.

101.

al-Qatari

Haran

Determinants of users’ satisfaction with primary health care settings and services in Saudi Arabia. International Journal for Quality in Health Care 1999; 11: 523–31.

102.

Quintana

Gonzalez

Bilbao

Aizpuru

Escobar

Esteban

, et al. Predictors of patient satisfaction with hospital health care. BMC Health Services Research 2006; 6: 102.

103.

Rahmqvist

Bara

AC.

Patient characteristics and quality dimensions related to patient satisfaction. International Journal for Quality in Health Care 2010; 22: 86–92.

104.

Raleigh

Frosini

Sizmur

Graham

Do some trusts deliver a consistently better experience for patients? An analysis of patient experience across acute care surveys in English NHS trusts. BMJ Quality & Safety 2012; 21: 381–90.

105.

Rahmqvist

Patient satisfaction in relation to age, health status and other background factors: A model for comparisons of care units. International Journal for Quality in Health Care 2001; 13: 385–90.

106.

Redmond

Sorrell

JM.

Studying patient satisfaction: Patient voices of quality. Outcomes Management for Nursing Practice 1999; 3: 67–72.

107.

Sahin

Yilmaz

Lee

KH.

Factors affecting inpatient satisfaction: Structural equation modeling. Journal of Medical Systems 2007; 31: 9–16.

108.

Salin

Kaunonen

Aalto

Explaining patient satisfaction with outpatient care using data-based nurse staffing indicators. Journal of Nursing Administration 2012; 42: 592–7.

109.

Saultz

Albedaiwi

Interpersonal continuity of care and patient satisfaction: A critical review. Annals of Family Medicine 2004; 2: 445–51.

110.

Senarath

Gunawardena

Sebastiampillai

Senanayake

Lekamge

Seneviratna

, et al. Patient satisfaction with nursing care and related hospital services at the National Hospital of Sri Lanka. Leadership in Health Services 2013; 26: 63–77.

111.

Sovd

Mmari

Lipovsek

Manaseki-Holland

Acceptability as a key determinant of client satisfaction: Lessons from an evaluation of adolescent friendly health services in Mongolia. Journal of Adolescent Health 2006; 38: 519–26.

112.

Swan

Richardson

Hutton

JD.

Do appealing hospital rooms increase patient evaluations of physicians, nurses, and hospital services?

Health Care Management Review 2003; 28: 254–64.

113.

Szecsenyi

Goetz

Campbell

Broge

Reuschenbach

Wensing

Is the job satisfaction of primary care team members associated with patient satisfaction?

BMJ Quality & Safety 2011; 20: 508–14.

114.

Tokunaga

Imanaka

Influence of length of stay on patient satisfaction with hospital care in Japan. International Journal for Quality in Health Care 2002; 14: 493–502.

115.

Tokunaga

Imanaka

Nobutomo

Effects of patient demands on satisfaction with Japanese hospital care. International Journal for Quality in Health Care 2000; 12: 395–401.

116.

Venn

Fone

DL.

Assessing the influence of socio-demographic factors and health status on expression of satisfaction with GP services. Clinical Governance: An International Journal 2005; 10: 118–25.

117.

Victoor

Delnoij

Friele

Rademakers

JJ.

Determinants of patient choice of healthcare providers: A scoping review. BMC Health Services Research 2012; 12: 272.

118.

Vinagre

Neves

The influence of service quality and patients’ emotions on satisfaction. International Journal of Health Care Quality Assurance 2008; 21: 87–103.

119.

Vinagre

Neves

Emotional predictors of consumer’s satisfaction with healthcare public services. International Journal of Health Care Quality Assurance 2010; 23: 209–27.

120.

Weisman

Henderson

Schifrin

Romans

Clancy

CM.

Gender and patient satisfaction in managed care plans: Analysis of the 1999 HEDIS/CAHPS 2.0H Adult Survey. Women’s Health Issues 2001; 11: 401–15.

121.

Westaway

Rheeder

Van Zyl

Seager

JR.

Interpersonal and organizational dimensions of patient satisfaction: The moderating effects of health status. International Journal for Quality in Health Care 2003; 15: 337–44.

122.

Williams

Meltzer

Arora

Chung

Curlin

FA.

Attention to inpatients’ religious and spiritual concerns: Predictors and association with patient satisfaction. Journal of General Internal Medicine 2011; 26: 1265–71.

123.

Wong

Leung

Cheung

Yam

Yeoh

Griffiths

A population-based survey using PPE-15: Relationship of care aspects to patient satisfaction in Hong Kong. International Journal for Quality in Health Care 2011; 23: 390–6.

124.

Woodside

Frey

Daly

RT.

Linking service quality, customer satisfaction, and behavioral intention. Journal of Health Care Marketing 1989; 9: 5–17.

125.

Xiao

Barber

JP.

The effect of perceived health status on patient satisfaction. Value in Health 2008; 11: 719–25.

126.

Zaghloul

Youssef

El-Einein

NY.

Patient preference for providers’ gender at a primary health care setting in Alexandria, Egypt. Saudi Medical Journal 2005; 26: 90–5.

127.

Zineldin

The quality of health care and patient satisfaction: An exploratory investigation of the 5Qs model at some Egyptian and Jordanian medical clinics. International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services 2006; 19: 60–92.

128.

Ladhari

Rigaux-Bricmont

Determinants of patient satisfaction with public hospital services. Health Marketing Quarterly 2013; 30: 299–318.

129.

Kim

Interpersonal caring: A theory for improved self-esteem in patients with long-term serious mental illness – I. Asian Nursing Research 2007; 1: 11–22.

130.

Gulliford

Figueroa-Munoz

Morgan

Hughes

Gibson

Beech

, et al. What does ‘access to health care’ mean? J Health Serv Res Policy 2002; 7: 186–8.

131.

Tucker

JL.

The moderators of patient satisfaction. Journal of Management in Medicine 2002; 16: 48–66.

132.

Gulliford

Naithani

Morgan

What is ‘continuity of care’?

Journal of Health Services Research & Policy 2006; 11: 248–50.

133.

Parasuraman

Zeithaml

Berry

LL.

A conceptual model of service quality and its implications for future research. Journal of Marketing 1985; 49: 41–50.

134.

Batbaatar

Dorjdagva

Luvsannyam

Amenta

Conceptualisation of patient satisfaction: A systematic narrative literature review. Perspect Public Health 2015; 135: 243–50.

135.

Roter

Rosenbaum

de Negri

Renaud

DiPrete-Brown

Hernandez

The effects of a continuing medical education programme in interpersonal communication skills on doctor practice and patient satisfaction in Trinidad and Tobago. Medical Education 1998; 32: 181–9.

136.

Stevens

Reininga

Boss

van Horn

JR.

Patient satisfaction at and after discharge. Effect of a time lag. Patient Educ Couns 2006; 60: 241–5.

137.

Almeida

Bourliataux-Lajoinie

Martins

Satisfaction measurement instruments for healthcare service users: A systematic review. Cadernos de Saúde Pública 2015; 31: 11–25.

138.

Dorjdagva

Batbaatar

Dorjsuren

Kauhanen

. Explaining differences in education-related inequalities in health between urban and rural areas in Mongolia. International journal for equity in health. 2015 Dec 1; 14(1): 1–2. Available at: http://doi.org/10.1186/s12939-015-0281-9139.

139.

Dorjdagva

Batbaatar

Dorjsuren

Kauhanen

. Income-related inequalities in health care utilization in Mongolia, 2007/2008 -2012. International Journal for Equity in Health. 2015; 14(57). Available at: http://doi.org/10.1186/s12939-015-0185-8

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