title: Beyond service quality: the mediating role of patient safety perceptions in the patient experience-satisfaction relationship.
abstract: BACKGROUND
  Although the extant literature on patient safety is rich, few studies have specifically examined safety from the patient perspective. In addition, little is known about how patients decide whether they are safe or satisfied with their care. From a foundation of attribution theory, we suggest that patients may interpret service quality lapses as risks to their safety, and this will influence their evaluations of their care.
  
  
  OBJECTIVE
  The aim of this study was to examine the relationships among service quality, patient safety perceptions, and patient satisfaction by testing a model that hypothesized a mediating role for patient safety perceptions.
  
  
  METHODS
  Acute care patients with recent inpatient visits at three hospitals were surveyed (Hospital 1, n = 486; Hospital 2, n = 279; Hospital 3, n = 231) to examine the relationships among service quality, safety, and satisfaction.
  
  
  RESULTS
  Analysis found that patient safety perceptions partially mediated the relationship between service quality and satisfaction in Hospital 1 and fully mediated the relationship in the Hospitals 2 and 3. Thus, patient safety perceptions explained the relationship between service quality and satisfaction. Consistent with previous research, patients who reported service quality problems perceived risks to their safety.
  
  
  CONCLUSIONS
  Although practitioners focus heavily on the technical aspects of care, this study suggests that it would be worthwhile to pay closer attention to how patients evaluate processes of care, in particular, the processes they may use to infer their safety in the hospital.
authors.affiliation: Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia, USA. RathertC@health.missouri.edu
authors.forename: Cheryl
authors.initials: C
authors.lastname: Rathert
authors.forename: Douglas R
authors.initials: DR
authors.lastname: May
authors.forename: Eric S
authors.initials: ES
authors.lastname: Williams
mesh_terms: D000368:Aged; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care; D017751:Safety Management; D014481:United States