Table 1

Summary of factor and global satisfaction assessment studies

Author, year, and country	Factors assessed	Method of assessing factor satisfaction	Method of assessing global satisfaction	Main findings
Bjorvell and Steig¹⁵ 1991 Sweden	Perceived levels of information on arrival	100 point visual analogue scale (VAS)	“How do you feel?”	Increased satisfaction with respect, general treatment and staff attitude related to perceived level of initial information. p<0.05
			“Would you return?”
			100 point VAS scale
Booth et al³¹ 1992 UK	Waiting times	4 point Likert scale and open-ended questions	N/A	Satisfaction levels with components of waiting times. “Ideal” and target times derived.
Hansagi et al⁶ 1992 Sweden	Multiple patient and service factors, and triage category	Likert scale and open-ended questions	“Satisfaction with medical treatment”	Triage category and age related to global satisfaction. p<0.001
			“Satisfaction with general care”
			Weighted 4 point scale
Lewis et al⁸ 1992 Canada	Triage category, nursing care, physician care, environment, auxiliary staff, waiting times and information	3 point Likert scale and open-ended questions	“Overall satisfaction with ED visit”	Separate factor satisfaction levels given. Poor correlation between global satisfaction derived from specific satisfaction ratings and global satisfaction on direct questioning. Only triage category reported as strongly correlated
Lewis et al⁸ 1992 Canada		3 point Likert scale and open-ended questions	Weighted 3 point scale
Maitra et al¹⁶ 1992 UK	Waiting times, receptionist helpful, explanations of management, information on delays, interruptions, treatment discussion with doctor	Modified Likert scale and open-ended question	“Satisfied” or “not satisfied” with outcome of visit	Satisfaction correlates with wait to see doctor (p<0.003), doctor’s explanation of management (p<0.002), total time in ED (p<0.01)
Maitra et al¹⁶ 1992 UK		Modified Likert scale and open-ended question	Dichotomous response
Bursch et al¹³ 1993 USA	Multiple service factors	Likert scale and open-ended questions	“Overall, how satisfied with ED care?”	14 service factors correlated with global satisfaction. Top five were: perceived waiting time; caring nurses; ED staff organisation; caring doctor; information given. (r = 0.63 to 0.68)
Bursch et al¹³ 1993 USA	Multiple service factors	Likert scale and open-ended questions	Unspecified scale
Britten et al¹⁴ 1994 UK	None specified to patients. Twelve main themes identified from interview transcripts	Frequency and emphasis in interview transcript	N/A	Factors identified as important are: information; waiting time; quick pain relief; sensitivity to personal circumstances; excessive questions or examination; a pleasant environment
Thompson et al¹⁷ 1995 USA	Perceived waiting time	Likert scale	Describe your experience in the ED.	Perceived wait relative to expected wait correlates with overall satisfaction. p<0.001
Thompson et al¹⁷ 1995 USA	Perceived waiting time	Likert scale	Weighted 4 point scale.
Thompson et al¹⁸ 1996 USA	Perceived and actual waiting times (to see doctor and for entire visit). Explanation given of delays, and procedures. Staff attitudes	Open-ended questions	Describe experience.	Information and perceived wait (but not actual wait) correlate with global satisfaction. p<0.001
			Recommendation
			Weighted 4 and 3 point scales
Hall et al⁷ 1996 USA	Multiple demographic and service factors	Likert scale and open-ended questions	Recommendation	Nurse and doctor attitudes (care, courtesy, concern), and perceived wait intervals correlate with global satisfaction. No demographic factor correlated (including age)
Hall et al⁷ 1996 USA	Multiple demographic and service factors	Likert scale and open-ended questions	Weighted 5 point scale
Rhee et al¹⁹ 1996 USA	Nurse and doctor technical ability. Nurse and doctor “bedside manner”. Receptionist service. Perceived wait intervals	5 point Likert scale	Rate overall quality (weighted 5 point scale)	Patient perceptions of technical quality of care (p<0.001) and perceived waiting times (p<0.005) correlate with global satisfaction, and are more important than bedside manner
Rhee et al¹⁹ 1996 USA		5 point Likert scale	Recommendation (dichotomous)
Bruce et al³² 1998 UK	30 items on nursing care, environment, ancillary services and information	3 point Likert scales	N/A	Primary area of concern was information about length of waiting time
Yarnold et al¹¹ 1998 (two part study) USA	Perceived waiting times, information and explanations, staff attitudes	Likert scale	“Overall satisfaction” (symmetrical 5 point scale and weighted 4 point scale)	Overall satisfaction levels are almost perfectly predictable from ratings of perceived staff attitudes
Boudreaux et al¹² 2000 USA	22 items including registration, nurse and doctor factors, waiting times, discharge instructions and estimated length of stay	5 point Likert scale	Recommendation	Caring staff, perception of safety, understanding discharge instructions, nurse technical skills and waiting time predict overall satisfaction. (p<0.05) Perceptions of care outweighed demographics and visit characteristics. Some differences between predictors of overall satisfaction and likelihood to recommend
Boudreaux et al¹² 2000 USA		5 point Likert scale	Overall satisfaction
Morgan et al¹⁰ 2000 UK	16 varying paired combinations of doctor’s manner, waiting time, service accessibility, known doctor, consultation type, doctor’s shift.	Conjoint analysis (ranking of paired preferences)	N/A	Doctor’s manner and waiting times are the most important factors. Patients will tolerate a doctor who seems rushed if they can be seen sooner
Sun et al⁵ 2000 USA	Nine sociodemographic variables, 15 comorbid conditions, 18 process of care measures. Triage score, five service factors (courtesy, completeness of care, explanation, waiting time, discharge instructions). 19 specified problems	5 point Likert scale	“Overall satisfaction” (5 point Likert scale)	Significant process of care measures: triage status, number of treatments. Significant problems: no help when needed; poor explanation of problem cause and test results; not informed about waiting time, when to resume normal activities, or when to reattend. Significant patient factors: age and race. Willingness to return is strongly predicted by satisfaction
Sun et al⁵ 2000 USA		5 point Likert scale	Willingness to return (dichotomous response)