{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:16:21Z","timestamp":1788498981160,"version":"build-2803163510"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Introduction<\/jats:title>\n Patient satisfaction is a critical indicator of healthcare quality and a key driver for improvement in hospital services. This study aimed to assess the levels and regional variations in inpatient satisfaction across all 20 Ministry of Health (MOH) regional health clusters in Saudi Arabia.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A nationwide retrospective cross-sectional analysis was conducted using anonymized survey data from 90,867 inpatient respondents collected through the MOH Patient Experience Measurement Program. The dataset captured patient experiences across multiple domains, including overall care, staff hygiene, physician communication, waiting times, and pain management. As data were ordinal (five-point Likert scale), non-parametric Kruskal\u2013Wallis\n H<\/jats:italic>\n -tests were employed to compare median satisfaction scores across regions, supplemented by\n post-hoc<\/jats:italic>\n Dunn's tests with Bonferroni adjustment. Effect sizes (epsilon-squared, \u03b5\n 2<\/jats:sup>\n = H\/(n\u22121)) were calculated for all nine domains, and a Holm\u2013Bonferroni correction was applied across the family of omnibus tests. To identify the domains most strongly associated with the global rating of care, and to partition variation between hospitals and clusters, a proportional-odds ordinal regression and a three-level mixed-effects logistic model with respondents nested within hospitals within clusters were additionally fitted.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Differences between clusters were statistically significant in every domain (all Holm-adjusted\n p<\/jats:italic>\n &lt; 0.001) but negligible in magnitude (\u03b5\n 2<\/jats:sup>\n = 0.002\u20130.020, with \u03b5\n 2<\/jats:sup>\n &lt; 0.01 in eight of the nine domains). In the adjusted models the strongest correlates of the global rating were non-physician process domains\u2014courtesy at blood draw (proportional-odds ratio 1.51, 95% CI 1.47\u20131.55) and staff hand hygiene (1.49, 1.45\u20131.53)\u2014rather than physician communication (1.20\u20131.22). Between-hospital variance in a top-box global rating (variance-partition coefficient 4.4%) was more than four times the between-cluster variance (1.1%), and the cluster component fell to approximately zero once hospital was included in the model. The Jazan Health Cluster recorded the highest observed ratings in overall care, hand hygiene, and physician communication, whereas the Al-Jouf, Al-Ahsa, and Al-Madinah clusters recorded the lowest. After risk standardization for age band, sex, and survey year, 11 of the 20 clusters were statistically distinguishable from the national mean. Despite regional variations, aggregate data revealed high overall satisfaction, with most patients rating their experience as \u201cGood\u201d or \u201cVery Good\u201d\u2014for example, 72.81% rated staff hand hygiene as \u201cVery Good,\u201d and 74.86% rated physician concern for questions as \u201cVery Good.\u201d While significant inter-regional differences exist, overall patient satisfaction with MOH inpatient services in Saudi Arabia is high.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Because most of the modeled variation lies between hospitals rather than between clusters, quality-improvement effort is better targeted at facility level than at cluster level; clusters are accordingly described here as showing higher or lower observed ratings rather than as high- or under-performing. National healthcare policies should focus on standardizing protocols and sharing best practices to ensure equitable, high-quality patient care across all regions.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1882479","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:26:57Z","timestamp":1788496017000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Regional variations in inpatient satisfaction: a nationwide analysis of ministry of health hospitals in Saudi Arabia"],"prefix":"10.3389","volume":"14","author":[{"given":"Eid Khulaif","family":"Daeab","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]},{"name":"Molecular and Cell Biology Laboratory, Prince Naif bin Abdul Aziz Health Research Center (PNHRC), College of Dentistry, King Saud University Medical City, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansour A.","family":"Almanaa","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazeed I.","family":"Alashban","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma S.","family":"Alrushud","sequence":"additional","affiliation":[{"name":"Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar A.","family":"Alsadon","sequence":"additional","affiliation":[{"name":"Dental Health Department, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Essam S.","family":"Almutleb","sequence":"additional","affiliation":[{"name":"Optometry Department, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Alsaqr","sequence":"additional","affiliation":[{"name":"Optometry Department, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dara","family":"Aldisi","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud M. A.","family":"Abulmeaty","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed","family":"Alqarni","sequence":"additional","affiliation":[{"name":"Patient Experience Center, Ministry of Health","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mourad A. M.","family":"Aboul-Soud","sequence":"additional","affiliation":[{"name":"Center of Excellence in Biotechnology Research (CEBR), College of Applied Medical Sciences, King Saud University","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e32102","DOI":"10.7759\/cureus.32102","article-title":"Patient satisfaction with quality of care at the Kingdom of Saudi Arabia","volume":"14","author":"Almass","year":"2022","journal-title":"Cureus."},{"key":"B2","doi-asserted-by":"publisher","first-page":"193","DOI":"10.2147\/PPA.S496684","article-title":"National patient satisfaction survey as a predictor for quality of care and quality improvement\u2014experience and practice","volume":"19","author":"Cui","year":"2025","journal-title":"Patient Prefer Adherence."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e081185","DOI":"10.1136\/bmjopen-2023-081185","article-title":"Patient satisfaction among Saudi academic hospitals: a systematic review","volume":"14","author":"Alasiri","year":"2024","journal-title":"BMJ Open."},{"key":"B4","doi-asserted-by":"publisher","first-page":"358","DOI":"10.26719\/2004.10.3.358","article-title":"Inpatient satisfaction with physician services at King Khalid University Hospital, Riyadh, Saudi Arabia","volume":"10","author":"Al-Doghaither","year":"2004","journal-title":"East Mediterr Health J."},{"key":"B5","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1108\/09526861311288613","article-title":"Patients' satisfaction of service quality in Saudi hospitals: a SERVQUAL analysis","volume":"26","author":"Al-Borie","year":"2013","journal-title":"Int J Health Care Qual Assur."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1077147","DOI":"10.3389\/fpubh.2022.1077147","article-title":"Satisfaction of patients with health care services in tertiary care facilities of Riyadh, Saudi Arabia: a cross-sectional approach","volume":"10","author":"Aljarallah","year":"2023","journal-title":"Front Public Health."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2050","DOI":"10.3390\/healthcare12202050","article-title":"Key predictors of patient satisfaction and loyalty in Saudi healthcare facilities: a cross-sectional analysis","volume":"12","author":"Alodhialah","year":"2024","journal-title":"Healthcare."},{"key":"B8","doi-asserted-by":"publisher","first-page":"3277","DOI":"10.3390\/su16083277","article-title":"Transforming healthcare in Saudi Arabia: a comprehensive evaluation of Vision 2030's impact","volume":"16","author":"Mani","year":"2024","journal-title":"Sustainability."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1001\/jama.1988.03410120089033","article-title":"The quality of care: how can it be assessed?","volume":"260","author":"Donabedian","year":"1988","journal-title":"JAMA."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e001570","DOI":"10.1136\/bmjopen-2012-001570","article-title":"A systematic review of evidence on the links between patient experience and clinical safety and effectiveness","volume":"3","author":"Doyle","year":"2013","journal-title":"BMJ Open."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e0324737","DOI":"10.1371\/journal.pone.0324737","article-title":"Unveiling the drivers of patient satisfaction in the United States hospitals: assessing quality indicators across regions","volume":"20","author":"Hung","year":"2025","journal-title":"PLoS ONE."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1524","DOI":"10.1186\/s12913-022-08779-5","article-title":"Responsiveness of the healthcare system in the Kingdom of Saudi Arabia: evidence from a nationally representative survey","volume":"22","author":"Nikoloski","year":"2022","journal-title":"BMC Health Serv Res."},{"key":"B13","unstructured":"Baltimore, MD\n CMS\n HCAHPS: Patients' Perspectives of Care Survey"},{"key":"B14","unstructured":"Care\n Quality Commission\n \n \n NHS Adult Inpatient Survey: national Statistical Release"},{"key":"B15","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1177\/1077558714541480","article-title":"Examining the role of patient experience surveys in measuring health care quality","volume":"71","author":"Anhang Price","year":"2014","journal-title":"Med Care Res Rev."},{"key":"B16","unstructured":"The need to report effect size estimates revisited. 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