Alicia Lee

Date of Award


Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Leora Horwitz MD


The measurement of patient satisfaction has taken a prominent role in the assessment of healthcare quality. Patient dissatisfaction, however, is not well understood. While the concept of satisfaction often proves vague and difficult to accurately measure, experiences with dissatisfaction are more tangible. In order to more fully understand dissatisfaction and its relationship to patients expectations, we conducted a qualitative analysis of patient suggestions for improvements in hospital care. Data were obtained from telephone interview surveys of adult patients discharged from Yale-New Haven Hospital between July 1, 2007 and June 30, 2008. Patients were asked: If there was one thing we could have done to improve your experience in the hospital what would it have been? We randomly selected 10% of survey respondents and analyzed answers to this question using standard qualitative analytic techniques. A total of 976 of 9764 surveys were randomly selected; 439 (45.0%) included at least one suggestion in response to the study question. We identified six major domains of dissatisfaction. These domains corresponded to six implicit expectations for quality hospital care: 1) safety, 2) treatment with respect and dignity, 3) minimized wait times, 4) effective communication, 5) control over the physical environment and 6) high quality amenities, and each expectation was associated with unique emotional responses. Respectively, patients felt: 1) unsafe (7.7%), 2) disrespected (6.0%), 3) anxious and/or abandoned (15.8%), 4) confused and mistrustful (7.4%), 5) confined and imposed upon (15.6%) and 6) disappointed (6.9%) when expectations were not met. Dissatisfaction with hospital care was found to largely result from discrete episodes when expectations for care were not met. The expectations which emerged from our qualitative analysis represent patient-generated priorities for quality improvement in hospital care, which have previously not been adequately measured. Certain aspects of patient expectations were found to be in accordance with current quality improvement initiatives, while other aspects were found to be inadequately addressed.


This is an Open Access Thesis.

Open Access

This Article is Open Access