Abstract
Patient satisfaction is key in determining healthcare quality and essential in Saudi Arabia's Vision 2030 healthcare transformation. This study assessed outpatient satisfaction with healthcare services across Saudi Arabia. This is a secondary analysis of a nationwide, cross-sectional, standardized, self-administered Press-Ganey survey from various regions of Saudi Arabia. Patient satisfaction was measured across 10 domains across healthcare services with a 5-point Likert scale, which was then converted to a percentage-based mean score. Statistical analyses were done using SPSS, with results considered statistically significant at P < .05. Differences in patient satisfaction scores were observed. Males reported slightly higher satisfaction than females in 9 out of 10 domains, with mean scores of 78.6% for males and 77.3% for females. Adults over 65 years reported the highest overall satisfaction with a mean score of 81.1%. Regional differences were observed, with the Southern region reporting the highest satisfaction across all domains (82.6%) while the Western region reported the lowest (74.4%). Areas with the lowest satisfaction included waiting times, disabled patients’ accessibility, and administrative support, although scores in these domains still reflected generally favorable patient experiences. This study reveals the impact of demographic and regional differences on patients’ satisfaction with outpatient services across Saudi Arabia, with lower satisfaction among young adults and females.
Keywords
Introduction
Patient satisfaction (PS) is a fundamental measure of healthcare quality, reflecting the effectiveness, accessibility, and medical services’ responsiveness. High satisfaction levels are associated with better treatment adherence, improved health outcomes, and increased trust in healthcare providers. 1 Saudi Arabia's Vision 2030 is a national strategic initiative aimed at transforming various sectors, including healthcare, by enhancing service quality, expanding access, and embracing innovation. As part of this vision, improving PS through service efficiency, integration of digital healthcare solutions, and a focus on patient-centered care is a central objective. 2 Outpatient services are considered as a primary contact for nonemergency care and play a critical role in the patient healthcare process. Hence, high-quality outpatient care is essential for meeting the growing healthcare demands driven by population growth and evolving disease patterns.
Several key factors influence PS in outpatient settings, including waiting times, physician–patient communication, staff professionalism, facility cleanliness, and services’ accessibility.3–5 Studies from the United States and Europe highlight that smooth administrative processes, care continuity, and effective medical consultations significantly improve patients’ experience.6,7 Similarly, research from developing countries states that prolonged wait times, limited healthcare resources, and poor patient communication decrease satisfaction. 1
Several studies have examined PS within outpatient and hospital settings in the Kingdom of Saudi Arabia (KSA). Almass et al 8 reported that while patients were generally satisfied with medical staff competence and facility cleanliness, long waiting times and inefficient administrative procedures were common concerns. Senitan et al 9 emphasized that effective patient communication significantly enhanced PS, highlighting the importance of interpersonal skills alongside clinical expertise. Additionally, Algudairi et al 10 identified notable regional disparities in PS, with urban areas generally reporting higher satisfaction than rural regions due to differences in healthcare infrastructure and resource availability.
Given these findings, this study aims to assess PS in outpatient settings across different regions of KSA, with a specific focus on identifying variations in satisfaction scores based on demographic factors (such as age and gender) and geographic regions. By analyzing key domains, including registration, waiting times, physician interactions, diagnostic services, pharmacy experiences, and overall satisfaction, this research seeks to provide meaningful insights into service quality and patient experiences. The findings are intended to support the goals of Saudi Arabia's Vision 2030 by informing strategies for improving patient-centered care and enhancing the quality and efficiency of outpatient services nationwide. The results will offer evidence-based recommendations for policymakers, healthcare administrators, and providers to enhance outpatient care, reduce disparities, and align Saudi healthcare services with global best practices.
Methodology
This nationwide, cross-sectional study used secondary data from the standardized, self-administered Press Ganey survey, completed by patients who visited Ministry of Health (MOH) Outpatient Departments at tertiary healthcare facilities across KSA's Central, Eastern, Northern, Western, and Southern regions between January and December 2023. Participants were patients who consented to complete the MOH patient experience survey online. To enhance data quality and minimize bias, a third-party provider facilitated data collection and analysis. The survey was distributed via mobile phone through their registered mobile phones to all patients after each visit to any outpatient department in tertiary hospitals in KSA. All patients had a registered mobile number, as all appointments are reserved through SMS and the “Sehaty” application. For patients <18 years old, parents/guardians of children and adolescents completed the survey on their behalf, as the survey was sent to the registered mobile number, which would be the parents’/guardians’ mobile number.
Ethical approval was obtained from the Institutional Review Board (IRB) of the participating healthcare institutions.
Statistical Analysis
Surveys with incomplete responses, defined by <50% of survey completion, were excluded. Data analyzed was based on 32 questions covering 10 health services domains: registration (ease of access and efficiency), moving through the system (waiting times and transitions between services), nursing communication, physician interactions (communication, professionalism, and perceived quality of care), laboratory services, radiology services, pharmacy services (timeliness, accuracy, and availability of services), personal issues (privacy, respect, and support from healthcare providers), general assessment (overall experience), and disability considerations (services’ accessibility for disabled patients).
Each domain was assessed using multiple Likert-scale between 1 represented “very poor,” 2 “poor,” 3 “fair,” 4 “good,” 5 “very good,” and then converted into a 0-100 scale, where 0 represented “very poor,” 25 represented “poor,” 50 represented “fair,” 75 “good,” and 100 represented “very good.” Each respondent's OS score was calculated as the mean of all domain scores.
Descriptive statistics were used to summarize PS scores across different domains and demographic groups. Continuous variables were summarized as mean and standard deviation (SD), while categorical variables were summarized as number (n) and percentage (%). Comparisons of patient satisfaction scores across demographic variables—including age, gender, and region—were planned as part of the study objectives. Initial analyses involved descriptive statistics and overall group comparisons. Following identification of notable trends, post hoc pairwise analyses were conducted to further explore statistically significant differences between specific age groups and regional differences, with results presented in Supplemental Table 1. One-way analysis of variance was used to compare satisfaction levels by age and region. Pearson correlation was used to assess the relationship between OS and individual domain scores. Regression analysis was performed to identify significant OS predictors. All analyses were conducted using Statistical Package for the Social Sciences (SPSS) version 27.0 (IBM Corp, Armonk, NY), and a P-value of <.05 was considered statistically significant.
Results
Patient Population
A total of 124 874 surveys were collected, with 110 312 respondents having more than 50% completed surveys and included in the analysis. The respondents’ population included an even gender distribution, 51.4% females and 48.6% males, with a mean age of 38.2 ± 19.5 (Supplemental Table 2).
Regarding age distribution, the largest respondents’ proportion was within the 30 to 64 age group (58.5%). The ≤18 years group (17.6%) and the 19 to 29 years group (14.8%), while the elderly population (≥ 65 years) constitutes 9.1%.
Regional distribution showed that the Central region had the highest representation (30.3%), followed by the Western (27.1%) and Southern (21.8%) regions. The Eastern region had the lowest participation (8.5%) (Supplemental Table 2).
Overall PS and Satisfaction Scores (SS) Across Domains and Subdomains
The PS analysis revealed an overall positive experience, with an average SS of 78.4. Satisfaction with clinical service domains is summarized in Figure 1. Pharmacy (84.5), laboratory (85.2), and radiology (83.7) were among the highest-rated areas. In pharmacy, 71.8% gave a “very good” score to the pharmacist's explanation, while 67.7% of respondents rated their satisfaction with medication wait times as “very good,” indicating a high level of satisfaction in this domain.
Patient Satisfaction Scores by Domain.
Laboratory services performed similarly well, with 72.6% rating “very good” staff's skill in drawing blood and 69.7% the comfort shown during the process. Radiology also received high scores, with 66.6% of respondents selecting “very good” for wait times and 67.9% expressing high satisfaction with the clarity of test explanations. Nursing and Physician care maintained high scores, with 79.9 and 80.5, respectively (Figure 1). Also, in Supplemental Table 3, for nurse subdomains, 62.5% felt “very good” with how well they listened, and 62.8% noted their friendliness and courtesy. Physicians scored even higher in communication aspects, with 66.8% “very good” with how they explained conditions and 67.9% with their attention to concerns. Shared decision-making with physicians was rated as “very good” by 64.8% of respondents, while 64.8% indicated they would “very likely” recommend their physician to others.
In contrast, logistical and infrastructure-related domains scored lower. The “moving through” category, which covers wait times and comfort, had a lower mean of 71.3, with just 49.6% highly satisfied with overall clinic wait times and 49.3% with waiting area comfort (Supplemental Table 3). As shown in Table 1, only 51.3% of patients were highly satisfied with the ease of contacting the hospital. The “personal issues” domain also reflected challenges, with a mean satisfaction of 78.3, and only 47.6% were “very good” with parking availability, which was the lowest rated item. 63.8% gave “very good” to clinic cleanliness, and 65.8% with privacy protection.
Patient Satisfaction Scores by Age Group.
Accessibility for individuals with disabilities scored low, 76.9 (Figure 1). Only 57.8% expressed “very good” with designated parking, 59.2% with equipment availability, and 60.2% with staff responsiveness to their needs (Supplemental Table 3). Lastly, as shown in Figure 1, the general assessment domain scored 77.8, with 60.8% choosing “very good” for teamwork (Supplemental Table 3).
PS by Gender
The SS analysis is represented in Table 2. Males consistently reported slightly higher SS compared to females in most domains, except for the disability category, where females (77.2) scored higher than males (76.0). All gender-based differences in satisfaction scores across domains were statistically significant (P < .001), except for the disability domain, where females scored slightly higher than males (P = .003), as shown in Supplemental Table 5.
Patient Satisfaction Scores by Gender.
In health service domains, males reported higher satisfaction in registration (78.2 vs 77.3), moving through (71.9 vs 69.9), nurse (80.2 vs 78.8), and physician (80.8 vs 79.8) interactions. Similarly, males expressed greater satisfaction with laboratory (86.2 vs 83.3), radiology (84.2 vs 82.5), and pharmacy (84.4 vs 83.5) services.
Regarding personal and overall experiences, males also reported higher satisfaction in personal issues (78.5 vs 77.3), general assessment (78.1 vs 76.6), and OS (78.6 vs 77.3).
PS by Age Group
In Table 1, the mean SS across age groups reveals that younger individuals (≤18 and 19-29) generally reported lower satisfaction compared to older individuals. Specifically, the youngest group (≤18) had the lowest SS at 76.6 ± 30.1, followed by the 19 to 29 age group with a mean of 73.1 ± 29.8. In contrast, the 30 to 64 and ≥65 age groups showed consistently higher satisfaction levels, with the 30 to 64 group reporting a mean of 78.9 ± 25.9 and the ≥65 group reporting the highest mean SS of 81.1 ± 23.8. All age group comparisons showed statistically significant differences in overall satisfaction scores (P < .001), as confirmed by posthoc pairwise analysis presented in Supplemental Table 3.
To further investigate these differences, posthoc pairwise comparisons were performed and presented in Supplemental Table 1. The comparison between the ≤18 and 19 to 29 groups indicated a mean difference of 3.99 (P < .001). Similarly, individuals in the 30 to 64 group reported higher satisfaction compared to those in the ≥18 group, with a mean difference of −1.81 (P < .001). The ≥65 age group also reported significantly higher satisfaction than the ≤18 group, with a mean difference of −3.98 (P < .001).
The 30 to 64 group showed a mean difference of −5.81 compared to the 19 to 29 group, indicating that individuals aged 30 to 64 were significantly more satisfied. Additionally, the ≥65 group had a mean difference of −7.97 compared to the 19 to 29 group. However, the comparison between the 30 to 64 and ≥65 groups revealed a smaller mean difference of −2.17.
PS by Region
The results indicate significant regional differences in PS across all domains (Table 3). The Southern region consistently reported the highest SS, with the highest values for pharmacy (88.2), radiology (87.9), and laboratory (87.6). In contrast, the Western region had the lowest satisfaction across most domains, with particularly low scores for moving through (66.3), general assessment (73.5), and disability (72.7).
Comparison of Patient Satisfaction Across Different Regions of KSA.
Satisfaction with healthcare providers, including nurses and physicians, followed a similar trend, with the Southern region reporting the highest satisfaction (83.7 for nurses and 84.1 for physicians) and the Western region the lowest (76.0 for nurses and 77.4 for physicians). Similarly, the lowest OS was in the Western region (74.4), while the highest was in the Southern region (82.6) (Table 3). Finally, laboratory and radiology services also showed regional variations, with the highest satisfaction in the Southern region (87.6 and 87.9, respectively) and the lowest in the Northern (83.4 and 82.00) and Western regions (83.5 and 80.4).
To further assess these differences, post hoc analysis between regions was done. The mean differences showed significant pairwise differences in PS across regions (Supplemental Table 4), with the Southern region consistently exhibiting higher SS than all other regions. This was evident in several domains, including OS, where the Southern region outperforms with a mean difference of +8.19 compared to the Western region, and +6.07 compared to the Northern region.
All pairwise comparisons between Southern and the other regions were statistically significant (P ≤ .001), as shown in Supplemental Table 1. In the registration domain, the Southern region showed a mean difference of +3.26 compared to central, and a more pronounced difference of +8.19 compared to the Western region (P < .001). Similarly, the laboratory domain showed that the Southern region had a higher score with a mean difference of +2.81 when compared to the central region and +4.43 when compared to the Eastern region.
In contrast, regions like Western and Northern generally reported lower SS across domains, such as in the moving through domain, the Southern region leads by +10.44 points over the Western region (76.7 vs 66.3), and by +6.07 points over the Northern region (76.7 vs 70.6).
Correlation Analysis
A strong positive correlation between the overall OS mean score and each service domain is obtained. The strongest correlation was observed between general assessment and OS (r = 0.941). This was followed by personal issues (r = 0.911), moving through (r = 0.909), and nurse interactions (r = 0.902). Conversely, although still strongly positive, pharmacy services showed the lowest correlation with OS (r = 0.804) (data not shown).
Delving deeper into the general assessment domain (data not shown), individual items such as “How well staff worked together to provide care” and “Likelihood of recommending the center to others” were extremely strongly correlated with domain scores (r = 0.958 and 0.967, respectively). Meanwhile, items in the pharmacy domain (data not shown) also showed high correlations, notably “Waiting time to get medications” (r = 0.895) and “Pharmacist's explanation of your prescription” (r = 0.896).
Gender, Age, and Region as Determinants of PS
PS was influenced by gender, age, and regional disparities (Supplemental Table 5). When stratified by gender, males consistently reported higher satisfaction than females in nearly every region. In the central region, males reported 80.8 ± 24.6, while females reported 79.2 ± 24.7, showing a significant gender difference (P < .001). A similar pattern is observed in the Eastern and Northern regions, where males generally expressed higher satisfaction compared to females. However, in the Southern region, both males (83.0 ± 25.4) and females (81.7± 25.7) reported similarly high satisfaction levels, with a relatively narrow absolute difference compared to other regions. Age was also a key determinant, with older adults (≥65 years) reporting the highest satisfaction across all regions, particularly in the central and Southern regions, where their mean scores exceeded 80. In contrast, young adults (19-29 years) consistently exhibited the lowest satisfaction, especially in the Eastern, Northern, and Western regions (P < .001).
Satisfaction varied significantly across age groups. Older patients (≥65 years) generally reported the highest satisfaction levels, especially within the central region. For instance, males aged ≥65 in the central region reported 85.3 ± 19.5, which is the highest satisfaction across all groups. Similarly, females aged ≥65 in the Southern region reported 83.8 ± 23.3. In contrast, younger patients, particularly those aged 19 to 29, reported the lowest SS. In the Western region, females aged 19 to 29 reported the lowest satisfaction at 66.2 ± 29.5, while males in the same age group reported 66.1 ± 32.2. These low SS were also evident in the Northern region, where females aged 19 to 29 reported 68.3 ± 30.3, and males in the same group reported 69.7 ± 32.7.
The overall trend shows that satisfaction increases with age, with the elderly (≥65) reporting consistently high satisfaction across all regions, while younger patients (especially females aged 19-29) report lower satisfaction.
Furthermore, regression analysis revealed that age and gender significantly impact OS scores (data not shown). The positive B-coefficient for age suggests that older individuals tend to report higher satisfaction levels (β=0.104, P < .001). In contrast, females report lower SS compared to males (β = −1.248, P < .001).
Discussion
This study examined the factors influencing PS in KSA, with a focus on gender, age, and regional differences. KSA has undergone significant healthcare transformations recently, driven by the Vision 2030 initiative. 11 As part of these efforts, the government has invested in digital health solutions, hospital infrastructure improvements, and expanded private-sector involvement in healthcare delivery; however, still some changes need to be further made, as reported in this study. Previous studies in KSA have highlighted that long wait times, overcrowding, and variability in service quality between public and private hospitals are common concerns that influence patient perceptions.12,13
One of the most notable findings of this study is that gender has an impact on PS scores, with women reporting lower satisfaction than men. This aligns with previous research suggesting that female patients tend to be more critical of healthcare services, particularly in areas related to communication, provider empathy, and accessibility.14,15 Several factors may contribute to this difference in the Saudi context. Women may experience longer wait times, limited access to female healthcare providers, and sociocultural barriers that restrict their autonomy in healthcare decision-making. 16 Additionally, female patients are often more likely to seek medical care for themselves and their families, which could expose them to more frequent and potentially negative healthcare interactions. 1 Addressing gender-based services requires targeted interventions to improve the quality of care for females, such as increasing the number of female physicians, improving communication training for healthcare providers, and implementing more gender-sensitive healthcare policies.
Another key finding is the positive relationship between age and OS. Older adults consistently reported higher satisfaction with healthcare services, a trend that has been observed in both local and international studies.6,17 Several explanations could account for this pattern. Older individuals may have lower expectations of healthcare services, greater appreciation for medical care, or more long-term relationships with healthcare providers, leading to more positive evaluations of their experiences. 18 Additionally, they may require more frequent medical care and thus develop a higher trust level in healthcare professionals. In the Saudi context, cultural norms that emphasize respect for elders and strong family-centered care may also contribute to more favorable experiences among older adults. These patients may be more accepting of traditional care processes and less reliant on digital interfaces, aligning well with existing outpatient workflows. In contrast, younger patients—especially those in the 18 to 29 age group—often have higher expectations regarding efficiency, digital accessibility, and service responsiveness. These expectations, if unmet, can contribute to relatively lower satisfaction levels. 19
This study further revealed significant regional disparities in PS across multiple domains. Consistently, the Southern region outperformed all other regions, showing the highest satisfaction scores across nearly every domain, while the Western and Northern regions reported lower satisfaction levels across most domains. While previous studies have linked higher satisfaction to regions with more advanced healthcare infrastructure, better staff-to-patient ratios, and stronger governance structures,1,20 this pattern does not fully explain the findings in the Southern region. In fact, the Southern region is not typically characterized by having the most developed healthcare infrastructure in Saudi Arabia. Therefore, the high satisfaction observed may reflect other contributing factors such as patient expectations, cultural norms, or differences in how services are delivered and perceived in that region. These findings align with global literature that emphasize the importance of contextual and structural determinants in shaping patient experiences. For instance, previous studies emphasized that regional health service differences significantly contribute to PS, suggesting that enhancing service delivery in underserved regions could narrow the satisfaction gap. 20 The correlation findings provide additional insight into the key drivers of PS. The exceptional general assessment domain's high correlation with overall satisfaction suggests that perceptions of system integration and a willingness to recommend services are among the most influential satisfaction determinants. This aligns with prior research identifying patient–provider communication, care coordination, and perceived empathy as central to high satisfaction.1,20–24
Limitations
Although this study provides valuable insights into the relationship between demographic factors and PS, several limitations should be considered. First, while age and gender were significant predictors, other potentially influential factors, such as socioeconomic status, education level, healthcare facility type, and specific medical conditions, were not included in the analysis. This study also relied on self-reported data, which may be subject to recall bias or social desirability bias, potentially affecting the accuracy of satisfaction ratings. Additionally, elderly patients and individuals with limited access to digital technologies or who do not own phones may be underrepresented, as the survey distribution was primarily electronic. This could influence the generalizability of the findings, particularly regarding satisfaction levels among less digitally connected populations. Future research should consider alternative data collection methods to better capture the experiences of these groups.
Second, the study relied on quantitative measures of satisfaction, which, while useful for statistical analysis, may not fully capture the patient's experiences complexity. A mixed-methods approach that combines quantitative surveys with qualitative interviews or focus groups would provide a more in-depth understanding of patient perspectives. Additionally, since the study did not differentiate between different healthcare services and clinics, future research should explore how satisfaction varies across different healthcare settings. Finally, while SSs offer valuable insights, they should be interpreted alongside other outcome measures such as clinical effectiveness and equity to provide a comprehensive understanding of healthcare quality across regions.
Building on these findings, future research should explore additional factors influencing PS, including hospital infrastructure, staff attitudes, waiting times, and digital health solutions.
Conclusion
Our findings carry important implications not only for Saudi Arabia but also for the broader global healthcare community. This study provides a comprehensive, nationwide assessment of outpatient patient satisfaction amid Saudi Arabia's ambitious Vision 2030 healthcare transformation, a context marked by rapid system modernization, demographic shifts, and efforts to enhance patient-centered care. While many determinants of patient satisfaction—such as age, gender, and geographic location—have been studied extensively in other countries, our research highlights how these factors manifest uniquely within the Saudi context, influenced by cultural expectations, healthcare infrastructure disparities, and evolving patient–provider relationships.
The clear regional variations in satisfaction observed here underscore the critical role that local healthcare delivery models, resource allocation, and administrative efficiency play in shaping patient experiences. For instance, the Southern region's unexpectedly high satisfaction despite less advanced infrastructure suggests that factors like community engagement, staff attitudes, and alignment with patient expectations may be equally or more important than facility resources alone. This challenges a purely infrastructure-focused approach to healthcare quality improvement and calls for nuanced strategies that incorporate socio-cultural dimensions.
Demographically, the lower satisfaction among younger adults may reflect generational differences in expectations, especially concerning digital health solutions, service speed, and autonomy. This trend is likely applicable in other settings undergoing digital transformation, highlighting the need for tailored communication and service designs that resonate with younger populations.
Globally, healthcare systems striving to enhance patient satisfaction can learn from this study's demonstration of the interplay between demographic diversity and regional healthcare characteristics within a transforming system. It emphasizes that improving patient satisfaction requires more than standardized protocols; it demands localized assessments, culturally sensitive interventions, and continuous monitoring aligned with patient values and expectations.
Moreover, the study contributes to a growing body of evidence advocating for the integration of patient satisfaction metrics into healthcare quality frameworks, reinforcing their role as vital indicators for policy evaluation and resource prioritization. By establishing a robust baseline during a period of significant reform, this work enables ongoing benchmarking and the identification of emerging trends, guiding policymakers and healthcare leaders not only in Saudi Arabia but also in comparable middle- and high-income countries aiming for equitable, patient-centered care.
Supplemental Material
sj-docx-1-jpx-10.1177_23743735251406343 - Supplemental material for Assessment of Patient Satisfaction Levels and Determinants in Outpatient Clinics of Ministry of Health Tertiary Hospitals in Saudi Arabia: A Survey Analysis
Supplemental material, sj-docx-1-jpx-10.1177_23743735251406343 for Assessment of Patient Satisfaction Levels and Determinants in Outpatient Clinics of Ministry of Health Tertiary Hospitals in Saudi Arabia: A Survey Analysis by Mervat M El Dalatony, PhD, Abdulrahman O Almalki, DDS, MS, FACP, FRCDC, Abdulhakim M Alabdulmunim, MPH, Ghaida A Alzayer, BPH, Ghofran H Sulaimani, MBBS, SBPM, Jumanah A Alhazmi, MPH, Mashael M Almutawaa, BDS, MScD, Noura M Al-Shehri, MBBS, and Mohammed S Aldossary, MClinDent in Journal of Patient Experience
Footnotes
Acknowledgments
The authors would like to thank CTI Clinical Trial and Consulting Services for their counseling and publication support.
Consent to Participate
All patients provided consent to participate in this study.
Data Availability Statement
Data will be shared once requested.
Declaration of Conflicting Interest
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical Approval
Ethical approval was obtained from the Institutional Review Board at the Ministry of Health, Saudi Arabia.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
ORCID iDs
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References
Supplementary Material
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