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Beyond service quality: The mediating role of patient safety perceptions in the patient experience-satisfaction relationship

Rathert, Cheryl; May, Douglas R.; Williams, Eric S.

doi: 10.1097/HMR.0b013e318219cda1

Background: Although the extant literature on patient safety is rich, few studies have specifically examined safety from the patient perspective. In addition, little is known about how patients decide whether they are safe or satisfied with their care. From a foundation of attribution theory, we suggest that patients may interpret service quality lapses as risks to their safety, and this will influence their evaluations of their care.

Purpose: The aim of this study was to examine the relationships among service quality, patient safety perceptions, and patient satisfaction by testing a model that hypothesized a mediating role for patient safety perceptions.

Methodology: Acute care patients with recent inpatient visits at three hospitals were surveyed (Hospital 1, n = 486; Hospital 2, n = 279; Hospital 3, n = 231) to examine the relationships among service quality, safety, and satisfaction.

Findings: Analysis found that patient safety perceptions partially mediated the relationship between service quality and satisfaction in Hospital 1 and fully mediated the relationship in the Hospitals 2 and 3. Thus, patient safety perceptions explained the relationship between service quality and satisfaction. Consistent with previous research, patients who reported service quality problems perceived risks to their safety.

Practice Implications: Although practitioners focus heavily on the technical aspects of care, this study suggests that it would be worthwhile to pay closer attention to how patients evaluate processes of care, in particular, the processes they may use to infer their safety in the hospital.

Cheryl Rathert, PhD, is Assistant Professor, Health Services Management, Department of Health Management and Informatics, and Senior Scholar, Center for Health Ethics, University of Missouri School of Medicine, Columbia. E-mail:

Douglas R. May, PhD, is Professor and Codirector, International Center for Ethics in Business, School of Business, The University of Kansas, Lawrence. E-mail:

Eric S. Williams, PhD, is Professor of Health Care Management, College of Commerce and Business Administration, University of Alabama, Box 870225, Tuscaloosa. E-mail:

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

© 2011 Lippincott Williams & Wilkins, Inc.