Exclusion criteria
To ensure that the review focused on good-quality, generalizable evidence that would address the chosen research areas. It was decided to:
• Exclude all articles that were specific to a particular treatment, condition, facilities, disease or patient group. Psychiatry, Dentistry, psychotherapy, tertiary care, primary health care, Emergency department, out patients, Special Sections, telemedicine, specific instrument, home care, plastic surgery, food evaluation, military hospitals, private hospitals and conference articles were also excluded.
Inclusion criteria
• Include all articles that were related to inpatients in this setting:(public hospitals, teaching hospitals, university hospitals, general hospitals, state hospitals,
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One article excluded by quality appraisal[5]. Characteristics of the reviewed articles are brought in(appendex1), Factors extracted from full texts(appendix2).
After extracted effective factors, results imported to MAXqda software and segments coded(appendix3).
The structural framework for the review distinguished two groups of determinants: those relating to the respondents attributes and those relating to health service provider attributes.
Four main types of individual factors were identified: Expectations, Health status, socio-demographic and socio-economic characteristics(appendix4). health service provider characteristics affected by three factors: hospital properties(service quality and hospital features), staff(physician, nurse, other staff) satisfaction and Insurance(cost). (appendix4).
Analysis of coded segments by MAXqda, identified the model of our research. Main factors that affecting consumer satisfaction categorized at Figure1.
Most studies investigated several potential influencing factors. This chapter proceeds by examining the characteristics of the corpus of determinants studies, and then by presenting and discussing the evidence about individual and health service
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Table4: publication date of study
Study type n (%)
Observational 87 93.5
Qualitative 3 3.25 other 3 3.25
Expectations and satisfactions
Nineteen studies reporting that investigated the relationship between expectations of various types (Expectations, Values, beliefs, experiences) prior to the healthcare encounter and satisfaction after it. The main study features and findings are summarized in (appendix5,6).
There is evidence that a positive relationship between satisfaction and expectations; consumers with expectations of high-quality care reported higher levels of satisfaction and were more likely to return to and recommend their providers than people with lower expectations.
Good and bad “surprises” experienced in hospital have been observed to affect satisfaction, with bad events more significant than good ones.
Another study showed links between disconfirmation of expectations and perceived quality of care, and between perceived quality of care and satisfaction, but did not establish a direct connection between disconfirmation and
This group is more focused on satisfaction, access and quality of care. Providers, or practitioners, are also key stakeholders within an organization. The term provider can encompasses not only physicians and surgeons, but also nurses, physical and occupational therapists, technicians, and other members of a clinical staff. Providers fall into two categories, primary, which includes hospitals and health departments and secondary, which includes educational institutions and pharmaceutical companies. Providers are focused on the best treatments for patients and are involved in delivering health services and products. The final element of the MCQ model is the employer who by far is the largest paying and purchasing stakeholder of an organization. The employers focus is primarily on their return on investment within an organization. Cost and quality is a focus for employers when choosing health benefits but are mindful that access is just as important. Within the Patient Healthcare model, MCQ explains the interactions between the four elements of employer, patient, provider and payer while the Iron Triangle focuses on the factors of cost, quality, and access. The Patient Healthcare model charges healthcare leaders with the task of balancing satisfaction with the stakeholder (employer, patient, provider, and payer) in relation to cost, quality and access. This may be very difficult since stakeholders may have competing priorities. Changes and variations made in how healthcare organizations operate may have profound effects on how stakeholders perceive the quality, access and cost. For instance, a patient may consider cost to be a top priority when seeking healthcare and at the same time the healthcare organization may consider raising costs and therefore devaluing access and quality. Patients who begin to incur high out-of-pocket costs may begin to perceive a financial
Due to the increasing financial implications, patient satisfaction has become a growing priority for health care organizations, as well as transitioning the health care organization’s philosophy about the delivery of health care (Murphy, 2014). This CMS value based purchasing initiative has created a paradigm shift in health care in which leaders and clinicians must focus on patient centered care and the patient experience which ultimately will result in better outcomes. Leaders and clinicians alike must be committed to the patient satisfaction. As leaders within the organization, these groups must be role models and lead by example for front-line staff. Ultimately, if patients are satisfied, they are more likely to be compliant with their treatment plans and continue to seek follow up care with their health care provider, which will result in decreased lengths of stay, decreased readmissions, increased referrals and decreased costs (Murphy, 2014). One strategy employed by health care leaders to capture the patient experience, is purp...
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
Patient satisfaction surveys have been in debate being that the concept of ‘patient satisfaction’ is not clear and because this term means something different to everyone (Junewicz & Youngner, 2015). However, Junewicz and Younger (2015) discuss how these surveys can improve aspects of a patient’s care such as humanism, communication, safety, and confidentiality. The part that is still not covered is that these aspects patient satisfaction has no clear relationship with the technical quality of healthcare such as nosocomial infections, surgical complications, and readmission rates (Junewicz & Youngner, 2015).
Reviewed by:Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
[19]Press I. 2005. Patient Satisfaction: Understanding and Managing the Experience of Care, 2nd Edition. Chicago, IL: Health Administration Press.
In her paper emerging model of quality, June Larrabee discusses quality as a construct that includes beneficence, value, prudence and justice (Larrabee, 1996). She speaks of quality and value as integral issues that are intertwined with mutually beneficial outcomes. Her model investigates how the well-being of individuals are affected by perceptions of how services are delivered, along with the distribution of resources based on the decisions that are made (Larrabee, 1996). She speaks of the industrial model of quality and how the cornerstone ideas of that model (that the customer always knows what is best for themselves) does not fit the healthcare model (Larrabee, 1996). Larrabee introduces the concept that the patient va provider goal incongruence affects the provide (in this case the nurse) from being able to positively affect healthcare outcomes (Larrabee, 1996). The recent introduction of healthcare measures such as HCAHPS: Patients' Perspectives of Care Survey has encouraged the healthcare community to firmly espouse an industrial model of quality. HCAHPS is a survey where patients are asked questions related to their recent hospitalization that identifies satisfaction with case based solely on the individuals’ perception of the care given. This can lead to divergent goals among the healthcare team or which the patient is a member. Larrabee’s model of quality of care model
Health care must be fully accountable for quality and the patient experience is simply the patient's perception of quality. Society should question and debate on how healthcare organizations should show improvement for consumers. This can help organizations create reliable health coverage cost and evaluate medical performances for families and individuals in the future. Physicians and organizations are now evaluating patients with collection of electronic data to improve a patient’s...
According to Fred Lee (2004) hospitals use clinical results and process improvement as a gauge of quality as this data can be readily measured and objective. Conversely, patients judge the quality of care by individual perception. Therein a gap of what the patient’s perception of quality care and how the healthcare providers perceive quality of care is created. The purpose of this paper is to discuss the Gaps Model of Service Quality while comparing the findings of the work done by Fred Lee in the book, If Disney Ran Your Hospital: 91/2 Things You would Do Differently.
When caring for patients it is fundamentally important to have a good selection of up to date evidence Based Practice clinical articles to support research strategies, this allows professionals to assemble the most resent and accurate information known which enables them to make decisions tailored to the individual’s plan of care. It is essential to have clinical expertise and have the involvement from the individual patient, they must have full engagement and incorporation in order to have the accurate evaluation.
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia
Furthermore, they have also demonstrated the effect of EHR adoption with adjusting for nursing care in patient satisfaction. Here they have broadly pictured how nursing care facilitates the patient satisfaction outcomes. The precision model shows a statistically significant relationship.
Cliff, B. (2012, May/June). Excellence in patient satisfaction within a patient-centered culture. Journal of Healthcare Management, 57, 157-159. http://dx.doi.org/Retrieved from
consumers. However, there has been a continuous suggestion that the quality of care and the
Williams, P. & Naumann, E. 2011, "Customer satisfaction and business performance: a firm-level analysis", The Journal of Services Marketing, vol. 25, no. 1, pp. 20-32.