This investigation tested the patient-centered Primary Provider Theory of Patient Satisfaction across gender in national random samples of emergency patients. Using multigroup structural equation modeling, the results supported the model's robustness. Physician service, waiting time, and nursing satisfaction explained 48%, 41%, and 11% of overall satisfaction plus 92% and 93% of female and male satisfaction, respectively. Unit increases in physician service satisfaction increased waiting time, nursing, and overall satisfaction by 0.991, 0.844, and 1.031 units, respectively. Unit increases in waiting time satisfaction increased nursing and overall satisfaction by 0.417 and 0.685 units, respectively. A unit increase in nursing satisfaction increased overall service satisfaction by 0.221 units. The investigation offers an alternative paradigm for measuring and achieving emergency department satisfaction, hierarchically related to patient expectations, where the primary provider has the greatest clinical utility to patients, followed by waiting for the primary provider, and then by nursing service.
Institute of Medicine. Committee on the National Quality Report on Health Care Delivery. Board of Health Care Services. Envisioning the National Health Care Quality Report. Hurtado MP, Swift EK, Corrigan, JM, eds. Washington, DC: National Academy Press;2000.
2.
Institute of Medicine. Committee on Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press;2001.
3.
Yi Y. A critical review of consumer satisfaction. In: Zeithaml V, ed. Review of Marketing 1990. Chicago: American Marketing Association;1991:68-123.
4.
Aragon SJ. The Latent Structure of Emergency Room Satisfaction: A Structural Equation Modeling Investigation [dissertation]. Greensboro, NC: University of Chapel Hill; 2000.
5.
The Advisory Board Company. Heightened service scrutiny. In: Emergency Care Reform: Executive Briefing for Clinical Leaders. Clockwork ED Series. Washington, DC: The Advisory Board Company;1998:23-46.
6.
Donabedian A. The quality of care: how can it be assessed?JAMA. 1988;260:1743-1748.
7.
Drain M. Quality improvement in primary care and the importance of patient satisfaction. J Ambul Care Manag. 2001;24:30-46.
8.
Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Eval Program Plann. 1983;6:185-210.
9.
Press I. Patient satisfaction. Hosp Health Netw. 1994;68:60.
10.
Steiber SR, Krowinski WJ. Measuring and Managing Patient Satisfaction. Chicago: American Hospital Publishing;1990.
11.
Ware JE, Davies AR. Behavioral consequences of consumer dissatisfaction with medical care. Eval Program Plann. 1983;6:291-297.
12.
Ware JE, Hays RD. Methods for measuring patient satisfaction with specific medical encounters. Med Care. 1988;26:393-402.
13.
Kenagy JW, Berwick DM, Shore MF. Service quality in health care. JAMA. 1999;281:661-665.
14.
Pichert JW, Miller CS, Hollo AH, et al.What health professionals can do to identify and resolve patient dissatisfaction?Jt Comm J Qual Improv. 1998;24:303-312.
15.
Spiegel AD, Kavaler F. Better patient communications means lower liability exposure. Manag Care. August 1997;119-124.
16.
Hickson GB, Federspiel CF, Pichert JW, et al.Patient complaints and malpractice risk. JAMA. 2002;287:2951-2957.
17.
Bursch B, Beezy J, Shaw R. Emergency department satisfaction: what matters most?Ann Emerg Med. 1993;22:586-591.
18.
Hansagi H, Carlsson B, Brismar B. The urgency of care need and patient satisfaction at a hospital emergency department. Health Care Manag Rev. 1992;17:71-75.
19.
Maitra A, Chikhani C. Patient satisfaction in an urban accident and emergency department. Br J Clin Pract. 1992;46:182-184.
20.
McMillan JR, Younger MS, DeWine LC. Satisfaction with hospital emergency department as a function of patient triage. Health Care Manag Rev. 1986;11:21-27.
21.
Mowen JC, Licata JW, McPhail J. Waiting in the emergency room: how to improve patient satisfaction. J Health Care Mark. 1993;13:26-33.
22.
Rhee KJ, Bird J. Perceptions and satisfaction with emergency department care. J Emerg Med. 1996;14:679-683.
23.
Rhee KJ, Allen RA, Bird J. Telephone vs mail response to an emergency department patient satisfaction survey. Acad Emerg Med. 1998;5:1121-1123.
24.
Thompson DA, Yarnold PR. Relating patient satisfaction to waiting time perceptions and expectations: the disconfirmation paradigm. Acad Emerg Med. 1995;2:1057-1062.
25.
Thompson DA, Yarnold PR, Williams DR, et al.Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Ann Emerg Med. 1996;28:657-665.
26.
Carey RG, Seibert JH. A patient survey system to measure quality improvement: questionnaire reliability and validity. Med Care. 1993;31:834-845.
27.
Hall MF, Press I. Keys to patient satisfaction in the emergency department: results of a multiple facility study. Hosp Health Serv Adm. 1996;41:515-532.
28.
Yarnold PR, Michelson EA, Thompson DA, et al.Predicting patient satisfaction: a study of two emergency departments. J Behav Med. 1998;21:545-563.
29.
Bjorvell H, Stieg J. Patients' perceptions of the health care received in an emergency department. Ann Emerg Med. 1991;20: 734-738.
30.
Burroughs TE, Davies AR, Cira JC, et al.Understanding patient willingness to recommend and return: a strategy for prioritizing improvement opportunities. Jt Comm J Qual Improv. 1999;25: 271-287.
31.
Mack JL, File KM, Horwitz JE, et al.The effect of urgency on patient satisfaction and future emergency department choice. Health Care Manag Rev. 1995;20:7-15.
32.
Boudreaux ED, Ary RD, Mandry CV, et al.Determinants of patient satisfaction in a large municipal ED: the role of demographic variables, visit characteristics and patient perceptions. Am J Emerg Med. 2000;18:394-400.
33.
Campanella HC, Campanella PM, Grayson KG. Factors affecting department of defense patient satisfaction in a military emergency department. Mil Med. 2000;165:396-402.
34.
Hall MF, Press I. Keys to patient satisfaction in the emergency department: results of a multiple facility study. Hosp Health Serv Adm. 1996; 41:515-532.
35.
Nerny MP, Chin MH, Jin L, et al.Factors associated with older patients' satisfaction with care in an inner-city emergency department. Ann Emerg Med. 2001;38:140-145.
36.
Raper J, Davis BA, Scott L. Patient satisfaction with emergency department triage nursing care: a multicenter study. J Nurs Care Qual. 1999;13:11-24.
37.
Sun BC, Adams J, Orav EJ, et al.Determinants of patient satisfaction and willingness to return with emergency care. Ann Emerg Med. 2000;35:426-434.
38.
Thomason DA, Yarnold PR, Williams DR, et al.Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department. Ann Emerg Med. 1996;28:657-665.
39.
Hall JA, Dornan MC. Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta analysis. Soc Sci Med. 1990;30:811-818.
40.
The American Hospital Association. Hospital Statistics. Chicago: Healthcare InfoSource;1999.
