title: Organizational performance impacting patient satisfaction in Ontario hospitals: a multilevel analysis.
abstract: BACKGROUND
  Patient satisfaction in health care constitutes an important component of organizational performance in the hospital setting. Satisfaction measures have been developed and used to evaluate and improve hospital performance, quality of care and physician practice. In order to direct improvement strategies, it is necessary to evaluate both individual and organizational factors that can impact patients' perception of care. The study aims were to determine the dimensions of patient satisfaction, and to analyze the individual and organizational determinants of satisfaction dimensions in hospitals.
  
  
  METHODS
  We used patient and hospital survey data as well as administrative data collected for a 2008 public hospital report in Ontario, Canada. We evaluated the clustering of patient survey items with exploratory factor analysis and derived plausible dimensions of satisfaction. A two-level multivariate model was fitted to analyze the determinants of satisfaction.
  
  
  RESULTS
  We found eight satisfaction factors, with acceptable to good level of loadings and good reliability. More than 95% of variation in patient satisfaction scores was attributable to patient-level variation, with less than 5% attributable to hospital-level variation. The hierarchical models explain 5 to 17% of variation at the patient level and up to 52% of variation between hospitals. Individual patient characteristics had the strongest association with all dimensions of satisfaction. Few organizational performance indicators are associated with patient satisfaction and significant determinants differ according to the satisfaction dimension.
  
  
  CONCLUSIONS
  The research findings highlight the importance of adjusting for both patient-level and organization-level characteristics when evaluating patient satisfaction. Better understanding and measurement of organization-level activities and processes associated with patient satisfaction could contribute to improved satisfaction ratings and care quality.
authors.affiliation: Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 155 College St, 4th floor, Toronto, ON M5T 3 M6, Canada. anna.josette.kone@umontreal.ca.
authors.forename: Anna J
authors.initials: AJ
authors.lastname: Koné Péfoyo
authors.forename: Walter P
authors.initials: WP
authors.lastname: Wodchis
mesh_terms: D000368:Aged; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D015999:Multivariate Analysis; D009864:Ontario; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires