Abstract
Objectives:
This study aimed to assess patient satisfaction with services provided by the Ministry of Health (MOH) Emergency Departments (EDs) across different regions in Saudi Arabia, as well as describe patient satisfaction across MOH EDs emergency department domains, compare overall satisfaction by demographic groups, and identify key factors influencing patient perceptions.
Methods:
A retrospective observational analysis was conducted using secondary data from the Press Ganey survey collected through the MOH Patient Experience Program. The study included responses from patients who visited MOH-affiliated EDs across Saudi Arabia between January and December 2023. Satisfaction scores across multiple domains, including arrival experience, nursing care, physician care, laboratory services, and pharmacy services, were analyzed.
Results:
A total of 116,060 patient responses were analyzed. The overall satisfaction score was 71.41 ± 31.06. Satisfaction was highest in the laboratory (83.27 ± 29.51), radiology (84.12 ± 27.76), and pharmacy (84.51 ± 24.79) domains, while arrival care (65.56 ± 37.21) and parking (67.53 ± 37.19) received lower ratings. Significant regional differences were observed, with the Western region reporting the highest satisfaction (77.19 ± 29.93) and the Southern region the lowest (66.1 ± 31.68; p < 0.001).
Conclusions:
This study provides a large-scale assessment of patient satisfaction with MOH EDs across Saudi Arabia. Patient satisfaction with Saudi MOH EDs demonstrates moderate satisfaction overall, with significant variations across domains, regions, and demographic groups. These findings offer actionable insights: targeted interventions in low-performing regions, adoption of best practices from high-performing domains, and continuous quality improvement initiatives enhance patient experience and support the Saudi Vision.
Keywords
Introduction
As a cornerstone of its national transformation plan, Saudi Vision 2030 has prioritized the development of a value-based healthcare system that is both effective and patient-centered. Central to this vision is the enhancement of emergency care services, which serve as a critical gateway to the healthcare system for millions of citizens. 1 Measuring and improving patient satisfaction is not merely a goal but a strategic imperative, providing direct feedback on the system’s ability to meet public expectations and deliver high-quality care. 2
Saudi Arabia’s healthcare system operates hundreds of hospital-based Emergency Departments (EDs) to provide 24/7 acute care. As of 2021, the country had nearly 500 hospitals (public and private), with the Ministry of Health (MOH) overseeing 287 of them. 3 Saudi Arabia’s health system, primarily overseen by the MOH, provides preventive, curative, and rehabilitative care through a tiered model: a nationwide network of Primary Health Care (PHC) centers at the first contact level, and hospital-based secondary/tertiary services (including EDs) at referral levels. 4 Furthermore, hospital-based EDs handled approximately 13.6 million visits, according to MOH records. 3 This high patient volume reflects the critical role of EDs as the first point of contact for urgent health needs. However, such heavy utilization often leads to overcrowding, especially in non-urgent cases. Studies indicate that a large share of ED visits in Saudi Arabia (over 60% in one hospital study) are for lower acuity issues that could be managed in primary care. 5 This influx of non-emergency patients strains ED capacity and contributes to prolonged waiting times. 6
Key performance indicators (KPIs) are essential for monitoring and improving ED service quality, with length of stay (LOS) being a critical metric. 7 Nationally, the median ED LOS is 61 min, but at busy tertiary centers, 7 like Makkah, it can extend to over 3 h, contributing to delayed care and increased patient frustration, with up to 10% leaving without being seen. 8 Other key KPIs include door-to-doctor time, triage efficiency, left without being treated (LWBT) rates, patient satisfaction scores, adherence to clinical protocols, and re-admission rates within 48–72 h, all of which help ensure timely, effective, and high-quality emergency care. 9
Theoretically, patient satisfaction can be understood through frameworks like the Donabedian model, which evaluates healthcare quality based on three pillars: Structure (e.g. facilities, staffing), Process (e.g. diagnosis, treatment, communication), and Outcomes (e.g. health status, satisfaction).10,11 Patient satisfaction has emerged as an important measure of healthcare quality and is particularly pertinent in the high-stress ED setting 12 . Satisfaction reflects patients’ experiences with care, including factors like communication, environment, and wait times. 13 Assessing ED patient satisfaction is crucial because it highlights how well the system meets patient needs and expectations. 14 Recent studies in Saudi Arabia suggest that while many patients are satisfied with ED care, there is room for improvement. A single-center study in Riyadh reported an overall satisfaction score of around 70% (on a 0–100 scale), indicating moderate satisfaction 15 . Waiting time consistently emerges as a top concern impacting satisfaction. Patients who waited longer to see a doctor were significantly less satisfied in multiple studies.14,15 Nursing care and communication lapses are another noted challenge – one survey found that a considerable portion of patients rated ED nursing care as “poor” 14 .
Maintaining high-quality care in EDs is not only critical for patient outcomes but also for public trust in the health system. While monitoring KPIs provides objective data on performance, patient satisfaction surveys offer complementary insight from the patient’s perspective. Moreover, continuous quality improvement efforts in EDs, guided by patient satisfaction data, are essential. By regularly evaluating how patients perceive MOH ED services, healthcare leaders can implement targeted improvements to ensure timely, effective, and patient-centered emergency care. While previous studies have provided valuable single-center or limited regional snapshots, a large-scale analysis of patient satisfaction across all MOH EDs has been lacking. This represents a significant research gap, as understanding system-wide performance and identifying regional disparities are essential for equitable and effective national health policy. Therefore, the current study contributes to delivering a comprehensive, multi-regional perspective on ED patient satisfaction, benchmarking nine service domains to pinpoint actionable improvements and examining demographic factors that influence satisfaction. Furthermore, this study addresses the research question “What is the level of patient satisfaction with the emergency services in the MOH facilities across different regions in Saudi Arabia?” For instance, the current study aimed to illustrate the level of patient satisfaction with ED services in the MOH facilities in Saudi Arabia, through assessing the patients’ satisfaction with the ED services provided in the Saudi MOH, as well as describing patient satisfaction across MOH ED domains, comparing overall satisfaction by demographic groups, and identifying key factors influencing patient perceptions.
Methods
Study design and setting
This study is a retrospective, observational, and non-interventional analysis utilizing secondary data from the Press Ganey survey questionnaire. Data were collected from the MOH Patient Experience Program, which systematically gathers patient feedback on healthcare services. The study encompasses responses from patients who visited MOH-affiliated EDs across various regions in Saudi Arabia between January 2023 and December 2023, within an overall study timeframe of 2 years. The study included all the hospitals under the supervision of MOH, totaling 251 facilities. Ethical approval was obtained from the Institutional Review Board (IRB) of the Saudi MOH to ensure compliance with ethical guidelines for research involving human subjects (IRB log No: 25-39M). For patients aged ≤ 18, the survey link was sent to the registered mobile number of their parent or legal guardian, who provided implicit consent on behalf of the minor by proceeding with the survey. For all patients, patient confidentiality and anonymity were strictly maintained throughout the study, with no identifiable information included in any reports or analyses. All collected data were stored securely in accordance with MOH data protection policies. Furthermore, the reporting of this study conforms to the STROBE statement (supplementary checklist)
Study population and eligibility criteria
The study population included all patients who attended a MOH ED during the designated study period and completed the Press Ganey survey. Patients were eligible for inclusion if they had visited an MOH-affiliated ED between January 2023 and December 2023 and provided survey responses. Patients with incomplete survey responses, defined as answering fewer than 50% of the survey questions, were excluded from the analysis.
Data source and variables
Patient satisfaction data were obtained from the MOH Patient Experience Program through the Press Ganey survey. The Patient Experience Measurement Program has been introduced by the Saudi Arabia MOH as a part of a national transformation project aimed at enhancing patient experiences and achieving exceptional healthcare. This program monitors beneficiaries’ satisfaction with MOH services through tailored surveys, empowering patients and their families to contribute to quality improvement.16,17 The program is designed for use by primary healthcare centers, hospitals, specialized centers, premarital screening centers, and other therapy centers, ultimately extending its coverage to all MOH facilities. 18 The MOH manages surveys and publishes program-related reports in partnership with Health Links/Press Ganey, an independent organization that ensures compliance with the highest quality standards. Press Ganey, recognized globally for its expertise in patient experience evaluation, collaborates with more than 35,000 healthcare institutions worldwide, including more than 50% of the United States (US) hospitals. 16 Furthermore, the Press Ganey instrument is recognized internationally for its reliability and validity in measuring patient-centered care, making it a suitable tool for this large-scale analysis. The survey was distributed via SMS to patients’ registered mobile numbers following their ED visit, allowing them to provide feedback on their experience. Consent was acquired implicitly from participants who approved the completion of the questionnaire, including a statement about the study’s objectives and methodologies. Responses were collected electronically and stored within the MOH central database. The survey questionnaire consisted of 32 questions categorized into nine domains. For the purpose of this study, “services” are operationally defined as the comprehensive patient experience evaluated across these nine distinct domains. These domains included arrival experience, nursing care, physician care, laboratory services, radiology services, pharmacy services, facility and parking, personal care and communication, and general assessment. The retention of this nine-domain structure, which is inherent to the validated Press Ganey instrument, allows for a granular analysis of the patient journey and ensures consistency and comparability with international benchmarks. While domains like “Personal Issues” and “General Assessment” are cross-cutting, the instrument treats them as distinct constructs to capture overarching patient perceptions separate from specific departmental interactions. Each domain contained specific questions evaluating various aspects of patient experience, such as waiting times, interactions with healthcare providers, availability of services, and overall satisfaction. Responses were recorded using a five-point Likert scale, ranging from one (very poor) to five (very good), and were subsequently converted to percentage scores to facilitate interpretation and comparison across domains. In addition to satisfaction scores, demographic data were collected to assess potential factors influencing patient satisfaction. These variables included gender, age, nationality, and the geographical region of the ED visit.
Sample size considerations
As this study utilized secondary data, a formal sample size calculation was not required. A total of 116,060 patient responses were included in the analysis, providing a comprehensive dataset to evaluate satisfaction levels across MOH emergency departments.
Statistical analysis
Statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) software (IBM Inc., Chicago, Version 21.0). Descriptive statistics were used to summarize the demographic characteristics of the study population and patient satisfaction scores. Continuous variables, such as satisfaction scores, were expressed as mean, median, standard deviation (SD), and 95% confidence intervals (CIs). Categorical variables, such as gender and nationality, were presented as absolute numbers and percentages. For inferential analysis, independent t-tests were performed to compare satisfaction scores between the two groups. For comparisons involving multiple groups, one-way analysis of variance (ANOVA) was conducted when normality assumptions were met. Correlation analysis was employed to explore the strength and direction of the linear relationships between the individual service domain scores and the overall satisfaction score. Multiple linear regression analysis was employed to identify key predictors of patient satisfaction, adjusting for demographic and service-related factors. Regression results were reported as beta coefficients (β), 95% confidence intervals (CIs), and p-values. A p-value of less than 0.05 was considered statistically significant.
Results
Demographic characteristics
A total of 130,228 patients responded to the survey, of which 116,060 (89.12%) were fully completed and included in the analysis. Surveys with incomplete responses (10.88%) were excluded from the study. The mean age was 29.46 ± 19.97 years. Gender data were available for 77,507 participants, with males comprising 53.2% and females 46.8%. Regional distribution data were available for all participants, with the highest proportion from the Western region (28.8%), followed by the Central (26.8%), Southern (21.8%), Northern (14.9%), and Eastern (7.7%) regions (Table 1).
Demographic characteristics.
Satisfaction scores
The overall satisfaction score among participants was 71.41 ± 31.06, as shown in Table 2. In the arrival care domain, participants reported a mean satisfaction score of 65.56 ± 37.21. Satisfaction with the waiting time before staff noticed the patient’s arrival was rated as extremely satisfactory by 51.4% of participants, while 45.6% were extremely satisfied with the comfort of the waiting area. However, satisfaction with the waiting time before reaching the treatment area was slightly lower, with 45.2% expressing extreme satisfaction.
Satisfaction levels of participants.
Regarding the nurse care domain, the mean satisfaction score was 72.68 ± 35.41. Notably, 57.1% of participants reported extreme satisfaction with the courtesy of the nurses, while 55.9% were extremely satisfied with how well the nurses listened to their patients. Satisfaction with the nurse’s attention to patient needs and concern for privacy was slightly lower, with 54.7% and 58.1% reporting extreme satisfaction, respectively.
In the physician care domain, the mean score was 73.76 ± 35.57, with 62.3% of participants expressing extreme satisfaction with the courtesy of doctors. Satisfaction with physicians’ listening skills was rated as extremely satisfactory by 59.9%, while 56.9% of participants were highly satisfied with the doctor’s effort to involve them in treatment decisions. However, satisfaction with the doctor’s concern for patient comfort was slightly lower, with 57.0% expressing extreme satisfaction.
The laboratory domain had a mean satisfaction score of 83.27 ± 29.51, with 68.4% of participants being extremely satisfied with the concern shown for their comfort during blood draws. The radiology domain had a slightly higher mean score of 84.12 ± 27.76, with 68.0% of participants reporting extreme satisfaction with the waiting time for radiology tests, and 71.3% expressing high satisfaction with comfort during radiology procedures.
The pharmacy domain received a mean satisfaction score of 84.51 ± 24.79. Satisfaction was highest for the pharmacist’s explanation of prescriptions, with 71.2% of participants reporting extreme satisfaction, while waiting time for prescription filling was also highly rated at 70.3%. However, satisfaction with the availability of prescribed medications was slightly lower, with 65.9% expressing extreme satisfaction.
In the parking domain, the mean score was 67.53 ± 37.19, with 46.2% of participants expressing extreme satisfaction with the availability of parking. The personal issues domain received a mean score of 67.52 ± 36.58, with 54.4% of participants extremely satisfied with the information given about post-care management, while satisfaction with pain management was slightly lower at 47.9%.
The general assessment domain had a mean score of 71.89 ± 34.29. Among the specific aspects assessed, 57.2% of participants expressed extreme satisfaction with the staff’s concern for patient well-being, while 56.0% were highly satisfied with staff cooperation in patient care. The cleanliness of the emergency department was rated as extremely satisfactory by 55.1% of participants. However, satisfaction with the likelihood of recommending the emergency department to others was lower, with 51.2% expressing extreme satisfaction.
Satisfaction scores by region
Among the regions, the Western region had the highest rating (77.19 ± 29.93), with a mean difference (MD) of 4.36 (95% CI: 3.85 - 4.88; p < 0.001) compared to the Central region (72.83 ± 30.07). In contrast, the Southern region reported the lowest rating (66.1 ± 31.68), with an MD of −6.72 (95% CI: −7.20 to −6.25; p < 0.001), compared to the Central region. The Eastern (70.39 ± 29.64) and Northern (71.18 ± 32.23) regions also had significantly lower ratings than the Central region, with MDs of −2.44 (95% CI: −3.16 to −1.72; p < 0.001) and −1.65 (95% CI: −2.22 to −1.07; p < 0.001), respectively, as shown in Supplemental Table 1. Similarly, across most domains, the Western region consistently showed the highest satisfaction, particularly in nurse care (78.2 ± 33.66), physician care (78.52 ± 33.83), laboratory (86.89 ± 27.16), radiology (87.96 ± 25.46), pharmacy (87.72 ± 23.05), personal issues (74.23 ± 35.03), and general assessment (78.04 ± 32.41). Conversely, the Southern region consistently reported the lowest satisfaction scores across all domains, with the lowest ratings in arrival care (58.81 ± 37.87), parking (61.85 ± 38.13), personal issues (61.49 ± 37.33), and general assessment (65.96 ± 35.54). The Central, Northern, and Eastern regions demonstrated relatively similar satisfaction levels, with moderate differences across domains. While Eastern and Northern regions had slightly lower satisfaction in arrival care (63.79 ± 35.75 and 65.29 ± 38.37, respectively), they performed better in pharmacy services (82.62 ± 25.11 and 85.59 ± 24.28, respectively) compared to the Southern region, as shown in Table 3. The results of the post-hoc analysis comparing satisfaction scores across regions are presented in Supplemental Table 2.
Satisfaction scores categorized by region.
Satisfaction scores by age group
Regarding age groups, individuals aged ≥ 65 years reported the highest overall satisfaction (74.08 ± 28.79), with an MD of 4.30 (95% CI: 3.34 - 5.25; p < 0.001) compared to the ≤18 years group (69.78 ± 31.05). Similarly, those aged 30–64 years had a significantly higher rating (73.31 ± 30.16), with an MD of 3.52 (95% CI: 3.04–4.00; p < 0.001), whereas the 19–29 age group reported the lowest score among adults (65.96 ± 33.44), with an MD of −3.83 (95% CI: −4.43 to −3.23; p < 0.001), as shown in Supplemental Table 1. This trend was consistent across most domains, with the ≥65 group reporting the highest satisfaction in physician care (77.5 ± 32.35), nurse care (76.21 ± 32.48), and general assessment (74.81 ± 31.89). The 30–64 group had the highest satisfaction in the laboratory (84.36 ± 28.39), radiology (84.89 ± 26.73), pharmacy (85.58 ± 23.72), and arrival care (68.02 ± 36.1). Conversely, the 19–29 group reported the lowest satisfaction scores across most domains, with the lowest ratings in arrival care (59.47 ± 39.34), nurse care (66.23 ± 38.35), physician care (66.92 ± 38.78), and personal issues (61.65 ± 38.93). The ≤ 18 group had relatively higher satisfaction than the 19–29 group but scored lower than the older age groups in most domains, as reported in Table 4. The results of the post-hoc analysis comparing satisfaction scores across age groups are presented in Supplemental Table 3.
Satisfaction scores categorized by age group.
Satisfaction scores by gender
Table 5 shows that the overall satisfaction score was significantly higher in males (71.17 ± 31.45) compared to females (69.71 ± 31.04), with an MD of −1.46 (95% CI: −1.91 to −1.02; p < 0.001). Similarly, across most of the studied domains, males showed higher satisfaction scores than females, including laboratory services (83.76 ± 29.47 vs 81.23 ± 30.46), radiology (84.43 ± 27.85 vs 81.99 ± 28.85), nurse care (72.92 ± 35.52 vs 70.74 ± 35.82), physician care (73.49 ± 35.97 vs 72.35 ± 35.8), and general assessment (72.01 ± 34.49 vs 69.74 ± 34.61). However, females reported slightly higher satisfaction in parking (66.09 ± 37.15 vs 65.93 ± 38.21) and pharmacy (83.68 ± 24.84 vs 84.21 ± 25.35), though the differences were minimal.
Satisfaction scores categorized by gender.
Correlation analysis
The correlation analysis demonstrated significant associations between overall satisfaction and various care domains (p < 0.001). The strongest correlation was observed with General Assessment (r = 0.947, p < 0.001), followed by Personal Issues (r = 0.942, p < 0.001) and Nurse Care (r = 0.925, p < 0.001). Physician Care (r = 0.907, p < 0.001) and Arrival Care (r = 0.905, p < 0.001) also showed strong correlations, while Laboratory services had a slightly lower, yet still significant, correlation (r = 0.837, p < 0.001). Within the highest-correlated domain, General Assessment, staff cooperation in patient care had the strongest correlation (r = 0.954, p < 0.001), followed by staff attentiveness to patient needs (r = 0.943, p < 0.001) and the likelihood of recommending the emergency department (r = 0.937, p < 0.001), while overall cleanliness had a slightly lower correlation (r = 0.886, p < 0.001). In the Pharmacy domain, waiting time for prescription filling (r = 0.902, p < 0.001) and the pharmacist’s explanation of the prescription (r = 0.906, p < 0.001) showed stronger correlations compared to medication availability (r = 0.884, p < 0.001), as shown in Supplemental Table 4.
Regression analysis of overall satisfaction score
Age was positively associated with satisfaction, with higher age linked to increased satisfaction scores (B = 0.120, 95% CI: 0.109–0.131; p < 0.001). For instance, the positive coefficient for age (B = 0.120) means that as age increases, satisfaction scores rise, with each additional year contributing approximately 0.12 points to the overall score. In contrast, gender showed a significant negative association, with females reporting lower satisfaction compared to males (B = −1.632, 95% CI: −2.082 to −1.182; p < 0.001). Specifically, the negative coefficient for gender (B = −1.632) shows that being female is associated with a decrease of about 1.63 points in satisfaction compared to males. These coefficients quantify the impact of demographic factors on satisfaction, providing actionable insights for targeted improvements. Data are presented in Table 6.
Regression analysis of overall satisfaction scores by age and gender.
Subgroup analysis
The subgroup analysis revealed significant variations in overall satisfaction scores across different regions, age groups, and gender (p < 0.001). In all regions, satisfaction scores increased with age, with the highest ratings consistently observed in the ≥65 age group (p < 0.001). Among the regions, the Southern region reported the highest overall satisfaction (77.19 ± 29.93), while the Western region had the lowest (66.1 ± 31.68) (p < 0.001). Within each region, males generally reported higher satisfaction scores than females, with significant gender differences observed in the Eastern (p = 0.003), Northern (p = 0.003), and Southern (p < 0.001) regions. When comparing age groups within each gender, males in the 30–64 and ≥65 age groups reported significantly higher satisfaction scores than younger males across all regions (p < 0.001), while a similar trend was observed among females (p < 0.001). Across all comparisons, the 19–29 age group consistently reported the lowest satisfaction levels, as shown in Supplemental Table 5.
Discussion
This study provides critical insights into patient satisfaction across MOH EDs in Saudi Arabia, revealing an overall satisfaction score of 71.41 ± 31.06. Key findings highlight substantially higher satisfaction with technical services like pharmacy, radiology, and laboratory domains compared to lower satisfaction in arrival care, parking, and personal issues management. Significant variations were observed across geographic regions, age groups, and gender, with the Western region, older patients, and male participants reporting higher overall satisfaction levels.
The overall patient satisfaction score in this study represents moderate satisfaction with ED services across Saudi Arabia’s MOH facilities. This finding aligns with previous research mentioned in the Introduction section, which reported satisfaction scores of around 70% in a single-center study conducted in Riyadh. 15 Another study conducted by Aljudie et al. 13 showed moderate satisfaction toward ED services among ~3000 Saudi patients from different regions across the Kingdom. The consistency in these findings suggests that while emergency care in Saudi Arabia generally meets patient expectations, there remains substantial room for improvement in service delivery. When examining domain-specific satisfaction, our results reveal a notable pattern where technical services such as pharmacy, radiology, and laboratory achieved the highest satisfaction ratings, while front-end services, including arrival care and waiting areas, received lower ratings.
The relatively lower satisfaction with arrival care documented in our study mirrors findings from previous research in Saudi Arabia that identified waiting times as a critical factor affecting patient satisfaction. 15 As noted in the introduction, patients who experienced longer waiting times reported significantly reduced satisfaction levels in multiple studies.19,20 This persistent challenge suggests that despite ongoing improvements in Saudi healthcare infrastructure, managing patient flow and reducing waiting times remain significant opportunities for enhancing the patient experience. A study found that implementing a fast-track approach significantly improved patient satisfaction, increasing the overall satisfaction score from 68% to 88% (Odds ratio, OR 4.13, 95% CI: 2.32–7.33). This impact was greater than improvements resulting from staff caring (OR 2.82, 95% CI: 1.54–5.19) and pain control (OR 2.13, 95% CI: 1.16–3.92). 21 While all these factors significantly contributed to higher satisfaction, reducing waiting times had the most substantial effect.
Additionally, moderate satisfaction with personal issues management, including pain control and discharge instructions, represents an area requiring targeted improvement initiatives to align with international standards of patient-centered care. Research indicates a strong positive correlation between doctors’ provision of information and patient satisfaction.22,23 In the study of Aldossary et al., 15 who assessed the satisfaction of Saudi patients from the Central region toward emergency care, 33.8% of patients reported dissatisfaction with the clarity of information, particularly regarding side effects, symptoms, medication purpose, and the rationale and results of investigations.
The regional variations in satisfaction observed in our study, with the Western region demonstrating higher satisfaction compared to the Southern region, may reflect differences in resource allocation, staffing levels, or cultural expectations. The Western region, which includes major urban centers with tertiary healthcare facilities, may benefit from more advanced facilities and higher staff-to-patient ratios compared to other regions, particularly the Southern region, which encompasses more remote and less densely populated areas. Previous studies examining healthcare disparities within Saudi Arabia have documented similar regional variations, often attributing these differences to variations in healthcare infrastructure development and population density. Almass et al. showed that patients from the Central region reported higher overall satisfaction scores toward ED services compared to those from other regions. Additionally, they showed that patients from the Eastern region had the lowest satisfaction score. 13 Conversely, another study reported the highest satisfaction levels in the Southern province, followed by the Northern, Eastern, Central, and Western provinces. 24 However, this study was conducted during the COVID-19 lockdown, which may account for the significant discrepancy between its findings and those of the present study.
Age-related differences in satisfaction represent another significant finding, with older patients reporting higher satisfaction levels compared to younger age groups. This pattern contrasts with global healthcare satisfaction research, which commonly shows that older patients tend to report lower satisfaction across various healthcare settings.24 –27 Several factors may contribute to this phenomenon, including different expectations among younger patients who may have higher service expectations informed by consumer experiences in other sectors. Additionally, older patients typically receive more attentive care due to complex health needs and may experience greater gratitude for healthcare services, reflecting generational differences in healthcare expectations. 28
Our findings showed that there was a significant difference in satisfaction in both genders, with males reporting higher satisfaction than females. These differences might reflect varying healthcare experiences and expectations between genders, potentially influenced by cultural factors specific to Saudi Arabia. Studies examining gender-based healthcare disparities in the MENA region have suggested that female patients may have different communication preferences and expectations regarding privacy and personal care than their male counterparts.29 –31 A study conducted in Egypt showed that women are less satisfied with the services provided in primary healthcare centers than men. 25 They showed that female participants expressed lower satisfaction with most structural aspects of the services provided by PHCCs, including cleanliness and comfort. This may be attributed to a greater attention to detail in maintaining tidiness and hygiene, as well as a stronger preference for comfort compared to men. However, women reported higher satisfaction with the space available in examination rooms, laboratories, and X-ray facilities. Similarly, a study conducted in Korea found that women were more likely to express dissatisfaction when environmental conditions were inconvenient. 26 Additionally, research in the United States highlighted that women place greater importance on the overall appearance and sensory appeal of spaces and objects. 32 These findings emphasize the importance of gender-sensitive approaches to emergency care delivery to enhance satisfaction across all patient populations.
In our study, we observed significant positive correlations between overall satisfaction and key service domains, especially communication and nursing care. This aligns closely with findings by Alodhialah et al., 33 who reported that “questions on provider coordination and nursing care were most correlated with overall experience,” with the strongest domain being communication with nurses. Similarly, Alshahrani et al. 34 in Riyadh demonstrated that communication and interpersonal quality were among the most important predictors of satisfaction and even loyalty, with beta coefficients of 0.60–0.62 (p < 0.001). More broadly, systematic reviews in primary care contexts consistently identify communication, accessibility, technical competence, and the personal conduct of providers as central determinants of patient satisfaction. 35 Collectively, these findings emphasize that enhancing communication and nursing care should be central targets for interventions aimed at improving overall patient satisfaction and loyalty in healthcare settings.
Clinical implications
The study’s findings have important clinical implications for emergency care in Saudi Arabia. The lower satisfaction with arrival care and waiting times underscores the need for improved triage systems and patient flow management. Implementing evidence-based triage protocols and monitoring key performance indicators related to waiting times could enhance patient experience during the critical initial phase of emergency care. 36 Additionally, patient education on the triage process and real-time updates during waiting periods may help manage expectations and improve perceived care quality, even when wait times cannot be immediately reduced. 37 The high satisfaction with technical services, such as laboratory, radiology, and pharmacy, reflects well-functioning systems in Saudi emergency departments, suggesting that effective communication and efficiency strategies from pharmacy services could be applied to improve patient experiences during arrival and discharge. Leveraging successful practices across different domains may help improve the overall patient experience. The significantly lower satisfaction among younger patients (19–29 age group) indicates a gap in meeting their expectations, likely influenced by their preference for immediate information access and greater involvement in care decisions. Developing age-specific communication strategies and digital service offerings could address these disparities. Additionally, regional variations, particularly lower satisfaction in the Southern region, highlight the need for targeted quality improvement initiatives. Investigating potential factors such as resource availability, staffing, and cultural influences could help develop region-specific strategies, ensuring a more equitable emergency care experience across Saudi Arabia.
Recommendations for policymakers
To enhance patient satisfaction in Saudi EDs, the MOH should prioritize improving arrival care and waiting time management. Implementing digital queue systems, increasing triage nurses during peak hours, and redesigning waiting areas for greater comfort and privacy could address key concerns. These measures would help reduce dissatisfaction and minimize the number of patients leaving without being seen. Additionally, region-specific improvement strategies are needed to address geographic disparities, particularly in lower-performing regions like the Southern region. Targeted resource allocation for infrastructure, staffing, and training, along with knowledge-sharing programs from high-performing regions, could help bridge these gaps. Comprehensive staff training programs should be established to enhance communication skills and patient-centered care. Lower satisfaction with personal issues, such as pain management and discharge information, highlights the need for structured communication protocols and standardized approaches to pain assessment. Improved discharge planning with clear, culturally appropriate instructions would help ensure better patient understanding and smoother transitions. Additionally, patient segmentation strategies should be implemented to address varying expectations across demographic groups. Tailored approaches for younger patients, such as digital communication channels and enhanced patient involvement, as well as gender-sensitive care models, could help improve satisfaction among specific populations. Finally, the MOH should implement a continuous quality improvement framework for EDs, incorporating regular patient satisfaction assessments and targeted interventions. Benchmarking against national and international standards, sharing best practices, and recognizing high-performing facilities would help create a culture of ongoing improvement.
Strengths and limitations
This study’s strengths enhance its validity and generalizability. The large sample size (116,060 participants) provides robust statistical power, making it one of the largest patient satisfaction studies in Saudi Arabia’s EDs. Using the validated Press Ganey survey ensures reliable, internationally comparable measurements. The nationwide scope captures regional variations, offering a comprehensive view of patient satisfaction. Additionally, the domain-specific analysis provides detailed insights, highlighting strengths and areas for improvement beyond overall satisfaction scores.
Despite its strengths, this study has limitations. Its retrospective design prevents establishing causal relationships and identifying associations without determining underlying factors. Potential selection bias may exist, as patients with extremely positive or negative experiences may be more motivated to complete satisfaction surveys. This response bias could potentially skew the results toward the extremes of the satisfaction spectrum. The study does not account for confounders such as patient acuity, diagnosis, treatment outcomes, or ED characteristics, which may influence satisfaction independently. Additionally, individual-level socioeconomic indicators (education, income, urban/rural residence, family structure, employment conditions) were not captured in the patient experience survey and therefore could not be incorporated into our models. These omissions raise the possibility of residual confounding, especially for comparisons by region, age, and gender. The cross-sectional design captures only a single point, missing seasonal variations or trends. Additionally, the data were collected in 2023 and given the dynamic nature of healthcare services and patient expectations, these findings may not fully reflect patient satisfaction levels at the time of publication. Lastly, while the Press Ganey instrument is widely used, it may not fully capture all culturally specific aspects of patient experience relevant to the Saudi context. Future research using culturally adapted tools could provide deeper insights.
Conclusions
This study provides a comprehensive assessment of patient satisfaction across MOH EDs in Saudi Arabia, revealing moderate overall satisfaction with significant variations across service domains, regions, age groups, and gender. Key areas for improvement include arrival care and waiting time management. Additionally, regional disparities, particularly lower satisfaction in the Southern region, emphasize the necessity of targeted quality improvement initiatives to address local challenges and resource gaps. These findings offer valuable insights for healthcare leaders, clinicians, and policymakers aiming to enhance emergency care in Saudi Arabia. The MOH can improve patient satisfaction by implementing targeted interventions in low-performing areas, adopting best practices from high-performing regions, and establishing a continuous quality improvement framework. Such efforts would align with Saudi Vision 2030s healthcare excellence goals and global best practices in emergency medicine. Future research, including qualitative studies on patient experiences and longitudinal assessments of improvement initiatives, will further support evidence-based strategies to enhance emergency care quality across the Kingdom.
Supplemental Material
sj-docx-1-phj-10.1177_22799036261427946 – Supplemental material for Patient satisfaction levels with the services provided by the Ministry of Health Emergency Departments in Saudi Arabia
Supplemental material, sj-docx-1-phj-10.1177_22799036261427946 for Patient satisfaction levels with the services provided by the Ministry of Health Emergency Departments in Saudi Arabia by Mosa A. Shubayr, Hatoon M. Alamri, Hamoud M. Alrougi, Hanan H. Almalki, Nawal A. Sindi, Norah I. Aloraini, Walaa Y. Al-Adani, Ahmed S. Sabr and Mohammed S. Aldossary in Journal of Public Health Research
Supplemental Material
sj-pdf-2-phj-10.1177_22799036261427946 – Supplemental material for Patient satisfaction levels with the services provided by the Ministry of Health Emergency Departments in Saudi Arabia
Supplemental material, sj-pdf-2-phj-10.1177_22799036261427946 for Patient satisfaction levels with the services provided by the Ministry of Health Emergency Departments in Saudi Arabia by Mosa A. Shubayr, Hatoon M. Alamri, Hamoud M. Alrougi, Hanan H. Almalki, Nawal A. Sindi, Norah I. Aloraini, Walaa Y. Al-Adani, Ahmed S. Sabr and Mohammed S. Aldossary in Journal of Public Health Research
Footnotes
Acknowledgements
The authors would like to thank CTI Clinical Trial and Consulting Services for their counseling and publication support.
Ethical considerations
The study received ethical approval from the Institutional Review Board (IRB) (NCBE-KACST, KSA: H-01-R-009) of the Saudi MOH (IRB log No:25-39M) and was conducted in full accordance with the principles of the Declaration of Helsinki.
Consent to participate
Informed consent was obtained implicitly from participants who approved the completion of the questionnaire, including a statement about the study’s objectives and methodologies.
Author contributions
All authors made a substantial contribution to the study’s conception and design. They contributed to data collection, analysis, and writing the original draft of this manuscript. All of them read and approved the final version of the manuscript.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data availability statement
All data supporting the findings of the current study are available from the corresponding author on request.
Supplemental material
Supplemental material for this article is available online.
References
Supplementary Material
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