Assessing Patient Satisfaction in Tertiary Hospitals: The Impact of Social Factors and the Adaptation of HCAHPS in China

Background China's first standardized national patient satisfaction questionnaire, adapted from HCAHPS and detailed in the National Tertiary Public Hospital Performance Appraisal Operation Manual (2022), was introduced to assess healthcare quality nationwide. However, regional diversity raises concerns about its universal applicability, and differences between China’s and the U.S. social environments and healthcare systems necessitate further exploration of patient satisfaction factors. This study aims to evaluate the national satisfaction survey’s applicability in tertiary hospitals and identify key factors influencing inpatient satisfaction. Method A cross-sectional survey was conducted using the national standard satisfaction questionnaire at three tertiary general hospitals in Shenyang, Northeast China, between April 2022 and October 2023. Survey links were distributed via SMS 72 hours post-discharge or through QR codes during hospitalization for voluntary participation. Results A total of 2,535 valid responses were collected. Validity and reliability tests showed strong results (KMO = .940, Cronbach's Alpha = .874). Confirmatory Factor Analysis (CFA) indicated a well-fitting model, with five out of nine dimensions significant. These were ranked by standardized regression weight (SRW) as follows: Discharge Instruction (.58), Doctor Communication (.20), Nurse Communication (.11), Environment (.08), and Food (.05). CHAID decision tree analysis revealed key factors influencing patient satisfaction: Doctor Communication, Medicine Information and Discharge Instruction, Environment, and Food. Conclusion This study confirms that social factors such as the economy, 'filial piety' culture, and health insurance system significantly influence patient satisfaction. The pragmatic philosophy of the Chinese people prioritizes the determinants of patient satisfaction as follows: Doctor, Cost Details, and Living Conditions. While the intrinsic structure of the HCAHPS model is valid, certain item details may need to be modified to enhance its applicability within the Chinese patient population.