How patient reactions to hospital care attributes affect the evaluation of overall quality of care, willingness to recommend, and willingness to return

J Healthc Manag. Jan-Feb 2010;55(1):25-37; discussion 38.


Patient satisfaction is a critical part of the quality outcomes of healthcare. Every industry is interested in customer satisfaction because satisfied customers are loyal customers. Healthcare is no exception. Many research studies assume that satisfied patients are more likely to recommend their providers to their friends and to return when they need care again. Although this assumption sounds logical, we argue that three dependent variables-the Evaluation of Overall Quality of Care, Willingness to Recommend, and Willingness to Return-are unique constructs. Thus, we examine how patient reactions (experiences) to different hospital care attributes (factors or dimensions) influence these dependent variables. Our study analyzed a comprehensive patient satisfaction data set collected by BJC HealthCare. We used a multiple linear regression model with a scatter term to analyze 14,432 cases. In Evaluation of Overall Quality of Care model, we found that the nursing care attribute showed the strongest influence, followed by staff care. In assessing the other two models-Willingness to Recommend and Willingness to Return-we found that staff care showed the strongest influence, followed by nursing care. Patients put a different emphasis or a different priority on their reactions to hospital care attributes, depending on which outcome they arrive at. In addition, we found that patients are disproportionately influenced by a weak or poor attribute reaction, which is a conjunctive strategy (risk averse). In general, nursing care and staff care should be the first priority for improvement. This may be good news because these areas are under the control of hospital managers.

MeSH terms

  • Female
  • Hospitals*
  • Humans
  • Illinois
  • Male
  • Middle Aged
  • Missouri
  • Multi-Institutional Systems
  • Patient Acceptance of Health Care* / statistics & numerical data
  • Patient Satisfaction* / statistics & numerical data
  • Quality of Health Care*
  • Surveys and Questionnaires