A move toward patient dissatisfaction? A critical review of the disproportionate focus on patient satisfaction compared to dissatisfaction.

backgroundPatient satisfaction has been a widely used construct when measuring the patient perspective and a vital component of both patient-centered care and quality assurance. Nevertheless, several concerns regarding patient satisfaction have been raised in the literature. These include lack of definitional consensus and measurement standardization, consistently high satisfaction scores, and ceiling effects. Another concern is that striving for high satisfaction may incentivize pleasing the patient rather than delivering the highest-quality care.

objectiveThis critical review clarifies the concept of patient satisfaction, primarily by distinguishing it from related concepts such as patient experience and patient-centered care. The primary goal is to explore issues surrounding patient satisfaction and investigate its relationship with the underexamined concept of patient dissatisfaction. The discussion focuses on underlying problems and potential pathways toward improved usage and understanding of the patient satisfaction construct.

methodsGiven the conceptual nature of these topics, which are not easily addressed by a single research question, we chose an unsystematic critical review for its flexibility in addressing theoretical and methodological issues. DISCUSSION: Depending on the context and objective of its measurement, investigating and minimizing patient dissatisfaction may be more appropriate and may resolve many of the concerns raised by critics of patient satisfaction. This contrasts with current practices, which primarily focus on investigating and maximizing satisfaction. Thus, a complementary focus on patient dissatisfaction may offer utility for quality improvement. Finally, the article presents unresolved conceptual issues, along with suggestions for future research.

conclusionPatient dissatisfaction has remained a largely overlooked blind spot in patient satisfaction research and assessment. Resolving conceptual issues surrounding patient satisfaction and dissatisfaction and developing improved methods to identify pernicious dissatisfaction may render satisfaction scores more meaningful, thereby enhancing future quality-assurance evaluations.