Part of hospitals’ funding will depend on patient satisfaction ratings from 2010-11BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5451 (Published 11 December 2009) Cite this as: BMJ 2009;339:b5451
All rapid responses
It is interesting that the NHS in England in its attempts to improve
‘patient choice’ is now introducing patient satisfaction into the
equation. You quoted the NHS representative as recognising the inter-
relationship between patient demographics and socioeconomic factors on the
one hand, and patient satisfaction on the other: "Variations in people’s
expectations of what kind of service they should receive can be
considerable, and factors like geographical location, age, gender, and
ethnicity can all impact on the kinds of responses received.” 
There is a growing literature on the strengths and limitations of the
concept of patient satisfaction. The problem of defining satisfaction was
raised three decades ago.  However, despite considerable work in this
area there appears to be little consensus regarding the definition of the
concept,  and it is generally agreed that satisfaction is a
multidimensional concept determined by a variety of factors. 
It is debatable how closely patient satisfaction is related to the
quality of the services provided. Using the example of satisfaction with
hospital catering remind us that low levels of patient satisfaction with
hospital meals “does not reveal how important this issue is in relation to
other aspects of care. This characteristic of care with which patients are
least satisfied may also be the one with which they are least concerned.”
More generally, many satisfaction studies lack a conceptual or
theoretical basis [6,7,8,9] and the limitations of satisfaction as an
outcome measure have been well documented. Hence various authors have
argued convincingly that satisfaction studies should not be used to
allocate health care resources. [5,10,11,12] As Bennett also pointed out,
health service users’ views will inevitably be limited by their
expectation,  and there are complex linkages between expectations,
preferences and satisfaction. On top of this it has also been argued
that patients rarely evaluate care in terms of satisfaction.  Ryan
and colleagues pointed out that satisfaction studies are not the same as
public preference studies and one can question whether satisfaction
studies should be used in making decisions about allocating resources.
 Whilst Carr-Hill reminded us, “many ... researchers launch into
patient satisfaction surveys without realising the complexity of the
All in all, this suggest that there is a lot of debate about the ‘how’ and
‘whys’ of using the concept of patient satisfaction in health services
research, which needs to taken into consideration before NHS officials
embarked on another scheme that has little chance of improving UK health
care in the desired way.
Prof. Edwin van Teijlingen
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Competing interests: No competing interests