Asking patients what they like: overlooked attributes of patient satisfaction with primary care.

PURPOSE: Ask patients to describe important attributes of their primary health care; and use the responses to develop a taxonomy for classifying patient satisfaction.
DESIGN: Open-ended questions were administered to patients immediately after a clinic visit.
SETTING: Primary care clinics at an academically affiliated Veterans Affairs Medical Center in New England. PATIENTS: Two hundred two of 204 randomly selected English-speaking patients who agreed (and were able) to participate.
INTERVENTIONS: Clinimetric methods were used to obtain responses to three open-ended questions about what patients liked, disliked, and would like to see changed about their care. These "raw" descriptions were then combined into pertinent groups and arranged as a taxonomy of patient satisfaction.
RESULTS: The taxonomy was divided into five main axes referring to physician staff, nonphysician staff, attributes of the clinic, related services, and the institution. The axes contained a total of 34 items related to patient satisfaction. The items have demonstrable face validity, and are likely to be "transparently" sensible to clinicians and policy makers, but many of the items-such as problems with parking-were not included in either of two existing psychometric instruments used to measure patient satisfaction in the same clinics.
CONCLUSIONS: The clinimetric strategy leads to a simple, clinically relevant, and easily understood assessment of patient satisfaction with health care services. The assessment can be done with three simple questions; and the responses can be catalogued, when desired, in a suitable taxonomy.