Commentary: a patient-centered theory of satisfaction.

The Primary Provider Theory holds that patient satisfaction occurs at the nexus of provider power and patient expectations. More specifically, patient satisfaction is principally the function of an underlying network of interrelated satisfaction constructs--satisfaction with the primary provider, waiting for the provider, and satisfaction with the provider's assistant(s). Hierarchically linked to patient-centered expectations of provider value, the Theory specifies that primary providers offer the greatest clinical utility to patients. The Theory is operationalized by patient-centered measures exclusively, where only patients judge the quality of service and all other judgments are immaterial. Bearing in mind the Institute of Medicine's recent recommendations to clinicians regarding the implementation of a new level of patient-centered care, the Primary Provider Theory offers an alternative paradigm for the measurement and realization of patient satisfaction. It can inform patient-centered physician practice, medical education, quality improvement, outcome measurement, and satisfaction survey construction.