An evaluation of outpatient satisfaction in Chinese tertiary hospitals from a patient-centered perspective: a cross-sectional study

Abstract

Background: As a key indicator of healthcare service quality in Chinese tertiary hospitals, patient satisfaction measurement requires multidimensional assessment. However, existing tools predominantly focus on clinical efficiency while neglecting humanistic dimensions such as emotional support and personalized care. This oversight renders them inadequate to address contemporary patients' growing expectations for holistic, patient-centered care (PCC) experiences. Objective: This study aims to develop a patient-centered evaluation system for measuring outpatient satisfaction in Chinese tertiary hospitals. Methods: We surveyed 2,664 patients from three outpatient departments of tertiary hospitals in Guangzhou using a validated self-developed questionnaire assessing overall satisfaction (satisfied/not satisfied) and four domains: outpatient environment, outpatient process, PCC, and hospital services. The sample was randomly and equally split for exploratory and confirmatory factor analysis (EFA/CFA) to identify and validate satisfaction dimensions. A weighted satisfaction score was derived, with model robustness tested through binary Logistic regression and Receiver Operating Characteristic (ROC) curve analysis. Results: Overall satisfaction was reported by 43.39% of respondents, with significant variation by age (χ2 = 10.615, P = 0.014) and inverse correlation with waiting time (χ2 = 44.989, P = 0.001). EFA results indicated good internal consistency (KMO = 0.912; Bartlett's test P < 0.01), with all four domains showing significant positive correlations (P < 0.01). PCC emerged as the strongest contributor (26.19%), followed by hospital services (17.62%), outpatient process (16.95%), and outpatient environment (8.79%). CFA revealed key indicators: environmental safety (SMC = 0.751), waiting order management (SMC = 0.820), physician-patient relationship (SMC = 0.929), and doctor's diagnosis and treatment (SMC = 0.819). The weighted satisfaction score significantly predicted overall satisfaction (B = 3.244, P < 0.01), with ROC analysis confirming good predictive validity (AUC = 0.771, P < 0.01). Conclusion: This study establishes the first validated patient-centered satisfaction evaluation system for Chinese outpatient care, identifying PCC and hospital services as key determinants of satisfaction. The findings provide an evidence-based framework for optimizing healthcare delivery and informing policy reforms to better address patients' evolving expectations in tertiary hospital settings.