Overall patient satisfaction with hospitals: effects of patient-reported experiences and fulfilment of expectations

Background: Patient satisfaction and experiences are important parts of healthcare quality, but patient expectations are seldom included in quality assessments. The objective of this study was to estimate the effects of different predictors of overall patient satisfaction with hospitals, including patient-reported experiences, fulfilment of patient expectations and socio-demographic variables. Methods: Data were collected using a national patient-experience survey of 63 hospitals in the five health regions in Norway during the autumn of 2006. Postal questionnaires were mailed to 24 141 patients after their discharge from hospital. Non-respondents were sent a reminder after 4 weeks. Multivariate linear regression analysis including multilevel regression was used to assess the predictors of overall patient satisfaction with hospitals. Results: Thirteen variables were significantly associated with overall patient satisfaction: two variables about fulfilment of expectations, eight about patient-reported experiences and three socio-demographic variables. The regression model explained 59% of the variation in overall patient satisfaction. The most important predictor of patient satisfaction with hospitals was patient-reported experiences with the nursing services (beta=0.27, p< 0.001), followed by fulfilment of patient expectations (beta=0.21, p< 0.001), experiences with doctor services (beta=0.12, p< 0.001) and perceived incorrect treatment (beta=0.12, p< 0.001). Multilevel regression analysis confirmed most of the findings, but revealed that age was not a significant predictor of overall patient satisfaction. Conclusions: The study showed that both fulfilment of expectations and patient-reported experiences are distinct from but related to overall patient satisfaction. The most important predictors for overall patient satisfaction with hospitals are patient-reported experiences and fulfilment of expectations.