BMJ Qual Saf 20:959-965 doi:10.1136/bmjqs-2011-000306
  • Original research

Uncovering the blind spot of patient satisfaction: an international survey

  1. David W Bates1
  1. 1Division of General Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
  2. 2Centre of Emergency Medicine Research, Aarhus University Hospital, Aarhus, Denmark
  3. 3Department of Clinical Pharmacology, Aarhus University Hospital, Denmark
  4. 4NHS South Central, Newbury, Berkshire, UK
  5. 5Assaf Harofeh Medical Center, Zerifin, Israel
  1. Correspondence to Dr Ronen Rozenblum, Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, BS-3, Boston, MA 02120, USA; rrozenblum{at}
  1. Contributors All authors contributed to the study design, which was drafted by RR and DWB. RR, ML, PMH, OL-K and CAS contributed to the data collection. SL and CAS designed and performed the statistical analysis, and verified its accuracy. All authors helped draft this report and critically revise the draft. All authors reviewed and approved the final version of the report.

  • Accepted 23 August 2011
  • Published Online First 22 September 2011


Background To achieve a high level of patient satisfaction, providers need to identify and address patients' expectations. However, providers' beliefs and attitudes regarding expectations, as well as how to manage them, are not well understood.

Methods The authors developed a survey to assess clinicians' awareness, attitudes, competence and performance with respect to patient expectations. The authors surveyed clinicians in four academic hospitals located in Denmark, Israel, the UK and the USA.

Results The authors collected 1004 questionnaires (79.9% response rate) from four hospitals in four countries spanning three continents. Overall, 88.8% of respondents stated that clinician awareness regarding patient expectations was moderate to low, with significant differences between countries (p<0.001). Although 89.4% of clinicians believed it was important to ask patients about expectations, only 16.1% reported actually asking (p<0.0001). Nurses were more likely than physicians to ask patients about expectations (20.1% vs 11.5%, p<0.001). Only 19.6% of respondents felt they had adequate training to handle patients' expectations. In multivariate analyses, clinicians with greater awareness and adequate training were more likely to ask patients about their expectations.

Conclusion While clinicians think it is important to ask patients about their expectations, they often fail to do so and consequently may not respond adequately. These results identify a ‘blind spot’ in clinicians' approach when attempting to address patient expectations and improve patient satisfaction, suggesting that healthcare organisations should take a more active role in increasing clinicians' awareness and initiating structured training programmes to cope with patient expectations.


  • Funding This study was partially supported by the NHS South Central (UK). The funding was used for the travel expenses of RR to the UK (Oxford Radcliffe Hospital, Oxford) research site and to support the data analysis. NHS South Central was not involved in the study design, data collection, data analysis, data interpretation, writing of the manuscript or in the decision to submit the publication.

  • Competing interests None.

  • Ethics approval The study protocol and survey instrument were approved by the Institutional Review Board of each one of the four participating hospitals: Denmark (Aarhus University Hospital, Aarhus Sygehus); Israel (Assaf Harofeh Hospital, Zerifin); UK (Oxford Radcliffe Hospital, Oxford); and USA (Brigham and Women's Hospital, Boston).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Survey data are available from the corresponding author on request.

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