The role of clinical and process quality in achieving patient satisfaction in hospitals

Kathryn A. Marley, David A. Collier, Susan Meyer Goldstein

Research output: Contribution to journalArticlepeer-review

136 Scopus citations


Managers constantly struggle with where to allocate their resources and efforts in managing the complex service delivery system called a hospital. In the broadest sense, their decisions and actions focus on two important aspects of health care - clinical or technical medical care that emphasizes "what" the patient receives and process performance that emphasizes "how" health care services are delivered to patients. Here, we investigate the role of leadership, clinical quality, and process quality on patient satisfaction. A causal model is hypothesized and evaluated using structural equation modeling for a sample of 202 U.S. hospitals. Statistical results support the idea that leadership is a good exogenous construct and that clinical and process quality are good intermediate outcomes in determining patient satisfaction. Statistical results also suggest that hospital leadership has more influence on process quality than on clinical quality, which is predominantly the doctors' domain. Other results are discussed, such as that hospital managers must be mindful of the fact that process quality is at least as important as clinical quality in predicting patient satisfaction. The article concludes by proposing areas for future research.

Original languageEnglish (US)
Pages (from-to)349-369
Number of pages21
JournalDecision Sciences
Issue number3
StatePublished - Jan 1 2004


  • Health Care
  • Patient Satisfaction
  • Quality
  • Structural Equation Models


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