Patient satisfaction surveys: an opportunity for total quality improvement.

To identify deficiencies in the design and administration of patient satisfaction surveys and their actual use in institutional quality assurance programs we analyzed the survey instruments and practices of five teaching hospitals, three community hospitals, and two health maintenance organizations. There is a considerable gap between the content of many patient satisfaction surveys and what prior research has indicated to be important determinants of patient satisfaction. Often insufficient attention is directed to patient satisfaction with technical competence, outcomes, continuity, or patient expectations, and nonsystematic approaches and weak methodologies similarly limit the value of many patient surveys and inhibit their use in total quality improvement efforts.