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[Association between medical institution characteristics and patients' dissatisfaction based on the Patient's Behavior Survey in Japan].

OBJECTIVES
 Patients' dissatisfaction with medical practice is driven by several patient- and institution-related factors. However, little is known about the effect of institutional factors on patients' satisfaction. Accordingly, we examined institutional factors in determining patients' dissatisfaction using the Patient's Behavior Survey in Japan.


METHODS
 The combined database of the Patient's Behavior Survey, the Patient Survey, and the Survey of Medical Institutions from 2011 was used for the analysis. The item "overall patients' satisfaction" was used as the outcome for patient dissatisfaction. Medical institution factors were selected from the Survey of Medical Institutions, and patient factors, such as age, sex, and disease, were drawn from the Patient Survey. The analyses were conducted separately for inpatients and outpatients. Mixed-effects logistic regression, which accounts for the heterogeneity of institution type, was used to investigate the relationship between patients' dissatisfaction and institutional factors.


RESULTS
 There were 27,842 outpatients and 17,770 inpatients. In outpatients, founders (P<0.001), preventive measures for passive smoking (P<0.001), and training for new employees (P=0.002) were significantly related to patients' dissatisfaction. In inpatients, founders (P=0.037), preventive measures for passive smoking (P<0.001), the palliative care team (P=0.001), and training for new employees (P=0.013) were significant predictors. The heterogeneity among medical institution types was negligible for both outpatients and inpatients.


CONCLUSION
 Patient dissatisfaction was significantly associated with founders, preventive measures for passive smoking, and training for new employees for both outpatients and inpatients and with palliative care team only for inpatients. These items were indicators of improved hospital environments, and they represent key elements to ensure patient satisfaction in hospitals.