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There is no consensus in the literature as to how to define and measure the patient perspective on healthcare. Four different approaches have been described in a systematic review of the patient-satisfaction literature: approaches based on expectations; approaches based on health-service attributes; economic approaches; and holistic approaches. 1 These approaches differ in various ways. For example, expectation-based approaches focus on the association between expectations, perceived experiences and patient satisfaction, while the health-service attribute approach normally excludes satisfaction and expectations, instead focusing on patient-reported experiences on different health-service factors. Holistic approaches try to include all important predictors of patient satisfaction, thus providing a comprehensive framework for exploring interactions between variables that affect consumer evaluations. 1
One important application of patient evaluation is in the use of quality indicators. 2 3 In Donabedian's classical quality-measurement approach, patient satisfaction is included as an outcome measure together with changes in health, knowledge and behaviour. 2 The model also includes healthcare structures (conditions) and processes of care (activities), and requires a causal link between structure, process and outcome. 2 Following this model, patient satisfaction can be defined as a patient-reported outcome measure, while the structures and processes of care can be measured by patient-reported experiences. The causal link between structure, process and outcome might be expected theoretically, provided that patients are asked relevant and important questions about their healthcare experiences. This should be secured by a rigorous process of questionnaire development and validation. However, patient satisfaction is based on a subjective evaluation, and the holistic approach described above predicts that both actual experiences, patients' evaluations of these experiences, and other individual factors might affect patient satisfaction. In theory, this problem also relates to the concept of patient-reported experiences with the structures and processes of care, which necessitates some element of subjective evaluation. Consequently, the effects related to factors at the individual level should be estimated and accounted for when using patient evaluation in quality measurement.
Various individual-level factors might affect patient satisfaction. In addition to known socio-demographic predictors such as age and health, 1 patient expectations are often described as a major determinant of patient satisfaction. 1 4 There is no consensus about how to define and measure patient expectations. 5 One theoretical approach divides expectations into three different...