A hospital satisfaction measurement model for service improvement in a moroccan public hospital: psychometric validation and organizational diagnosis

Abstract

At the Provincial Hospital of Tetouan, patient satisfaction was studied as both a measurement issue and a useful source of hospital diagnosis. This article validates a multidimensional scale designed to organize patient feedback around the main stages of a public hospital pathway in Morocco. Data were collected between September and December 2023 through a single-center discharge survey involving 1,200 adult patients. Interviewing patients at discharge helped collect their views after admission, reception, waiting time, administrative procedures, medical care, information exchange, coordination, and preparation for going home. Validation involved ordinal recoding of responses, treatment of structural missing data, treatment of “not concerned” responses, reliability analysis, exploratory factor analysis, confirmatory factor analysis and assessment of convergent and discriminant validity. Factor analysis was based on 857 complete cases. The exploratory analysis retained eight factors that accounted for 74.796% of total variance. The final confirmatory model included 59 items in 10 correlated constructs and had an acceptable overall fit. The most clear and stable dimensions that emerged were clinical competence, clarity of explanations, relationships with doctors, relationships with nurses and caregivers, reception procedures, accessibility, the physical environment and discharge preparation. Other domains like perceived equity, coordination, continuity of care and expectations need to be interpreted more carefully due to their weaker psychometric structure. The final model should therefore be understood as a measurement structure and a diagnostic framework, not as a causal model. It can help hospital managers identify concrete areas for improvement, especially communication, accessibility, coordination, continuity of care, professional credibility, and patient-centered organization.