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Patient Satisfaction:  
Focusing on “Excellent”
Koichiro Otani, PhD, associate professor, Division of Public and Environmental 
Affairs, Indiana University–Purdue University, Fort Wayne; Brian Waterman, director 
of performance analytics, BJC HealthCare, St. Louis, Missouri; Kelly M. Faulkner, 
performance research analyst, BJC HealthCare; Sarah Boslaugh, PhD, performance 
research analyst, BJC HealthCare; Thomas E. Burroughs, PhD, executive director, 
SLUCOR (Center for Outcomes Research), and professor of internal medicine and 
health management and policy, Saint Louis University School of Medicine; and 
W.
 Claiborne Dunagan, MD, vice president of system quality, BJC HealthCare 
E X E C U T I V E   S U M M A R Y
In an emerging competitive market such as healthcare, managers should focus on 
achieving excellent ratings to distinguish their organization from others. When it 
comes to customer loyalty, “excellent” has a different meaning. Customers who are 
merely satisfied often do not come back. The purpose of this study was to find out 
what influences adult patients to rate their overall experience as “excellent.” The 
study used patient satisfaction data collected from one major academic hospital and 
four community hospitals. 
After conducting a multiple logistic regression analysis, certain attributes were 
shown to be more likely than others to influence patients to rate their experiences as 
excellent. The study revealed that staff care is the most influential attribute, followed 
by nursing care. These two attributes are distinctively stronger drivers of overall satis-
faction than are the other attributes studied (i.e., physician care, admission process, 
room, and food). Staff care and nursing care are under the control of healthcare 
managers. If improvements are needed, they can be accomplished through training 
programs such as total quality management or continuous quality improvement, 
through which staff employees and nurses learn to be sensitive to patients’ needs. 
Satisfying patients’ needs is the first step toward having loyal patients, so hospitals 
that strive to ensure their patients are completely satisfied are more likely to prosper.
For more information on the concepts in this article, please contact Dr. Otani 
Board at Purdue University, Ref. #0710005884.