Front Public Health. 2026 Sep 4;14:1882479. doi: 10.3389/fpubh.2026.1882479. eCollection 2026.
ABSTRACT
INTRODUCTION: 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.
METHODS: 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-Wallis H-tests were employed to compare median satisfaction scores across regions, supplemented by post-hoc Dunn's tests with Bonferroni adjustment. Effect sizes (epsilon-squared, ε2 = H/(n-1)) were calculated for all nine domains, and a Holm-Bonferroni 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.
RESULTS: Differences between clusters were statistically significant in every domain (all Holm-adjusted p < 0.001) but negligible in magnitude (ε2 = 0.002-0.020, with ε2 < 0.01 in eight of the nine domains). In the adjusted models the strongest correlates of the global rating were non-physician process domains-courtesy at blood draw (proportional-odds ratio 1.51, 95% CI 1.47-1.55) and staff hand hygiene (1.49, 1.45-1.53)-rather than physician communication (1.20-1.22). 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 "Good" or "Very Good"-for example, 72.81% rated staff hand hygiene as "Very Good," and 74.86% rated physician concern for questions as "Very Good." While significant inter-regional differences exist, overall patient satisfaction with MOH inpatient services in Saudi Arabia is high.
DISCUSSION: 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.
PMID:42760989 | PMC:PMC13585622 | DOI:10.3389/fpubh.2026.1882479