Christopher Borgstrom

The United States spends more money per capita on healthcare than any other industrialized nation,1 yet patients are the least satisfied with their care.2 Patient satisfaction is associated in both cross‐sectional3 and longitudinal studies4 with improved physical and mental health outcomes. Conversely, dissatisfaction with care hampers future medical interactions, prevents sharing of information, and impairs the building of trust.5 The increasing recognition that a patient's experience of care affects patient outcomes has furthered efforts to evaluate satisfaction with care.6, 7

However, patient satisfaction is challenging to define and understand. Even the definition of satisfaction is ambiguous, for to satisfy can mean both to make happy and the lesser, to be adequate. To dissatisfy is to displease or disappoint, but dissatisfaction is not the opposite of satisfaction: qualitative studies give little if any indication that patients evaluate satisfaction on a continuum ranging from dissatisfied at one end to very satisfied at the other.8 Instead, it appears that satisfaction and dissatisfaction are different constructs, such that patients may simultaneously be both satisfied and dissatisfied.9, 10 Patients often express overall satisfaction with a service or encounter while also reporting specific criticisms about its shortcomings.11, 12 Alternatively, consumers may be generally satisfied unless something unpleasant or improper happens.13 Thus, dissatisfaction and satisfaction may require different methods of measurement.

The most common model for measuring patient satisfaction is a quantitative survey of patients' experiences in specific predetermined domains. Of 54 hospital satisfaction surveys in common use, only 11 included patient input in their development,14 casting doubt on the relevance of these attributes to patients' priorities of care. Since it is well recognized that patient expectations influence satisfaction,8, 13, 15 it is important to identify patient expectations and priorities up front. However, these have not been clearly established. Furthermore, focusing purely on satisfaction with particular domains of care may miss the separate but illuminating construct of patient dissatisfaction.

In this study we therefore aim to understand patient dissatisfaction with hospitalization more fully as a means of elucidating implicit expectations for hospital care. Using qualitative techniques, we analyzed a large volume of patient responses to a single open‐ended study question to identify determinants and patterns of patient dissatisfaction.

Methods

Results

A total of 976 surveys was randomly selected from 9,764 postdischarge phone interviews completed between July 1, 2007 and June 30, 2008. A total of 56.3% of patients was female. Nearly half the patients were discharged from medical units (Table 1). Of the 976 patients, 439 (45.0%) gave at least one suggestion for improvement, yielding a total of 579 suggestions. Patients also offered numerous positive comments about their care, but these comments were not included in the analysis.

Through qualitative analysis, we assigned suggestions for improvement to six major categories of dissatisfaction: 1) ineptitude, 2) disrespect, 3) prolonged waits, 4) ineffective communication, 5) lack of environmental control, and 6) substandard amenities. We considered the inverse of these problems to represent six implicit expectations of good hospital care: 1) safety, 2) treatment with respect and dignity, 3) prompt and efficient care, 4) successful exchange of information, 5) environmental autonomy and control, and 6) high‐quality amenities (Table 2). The number of patient suggestions related to each domain is detailed in Table 3.

Discussion

We analyzed 439 patient suggestions for improving hospital care and found that dissatisfaction resulted from six categories of negative experiences: 1) ineptitude, 2) disrespect, 3) prolonged wait times, 4) ineffective communication, 5) lack of environmental control, and 6) substandard amenities. These domains represented a corresponding set of implicit patient expectations for: 1) safety, 2) treatment with respect and dignity, 3) prompt and efficient care, 4) successful exchange of information, 5) environmental autonomy and control, and 6) high‐quality amenities. Each of these categories suggests avenues by which both the assessment and provision of hospital care can be made more patient‐centered.

The most widely used patient satisfaction survey in use in the United States today is the Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS), which includes eight domains: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment.17 The dissatisfaction domains found in this study closely overlap the HCAHPS satisfaction domains, but with a few key differences.

First, dissatisfaction with ineptitude in our study encompassed concerns over adverse events and near misses, in addition to the cleanliness of the environment. Other research has shown that dissatisfaction with hospitalization can be predicted by the number of reported problems18 and the perception of receiving incorrect treatment.19 While elaborate methods have been devised to assess and compare the hospital quality and safety, patient satisfaction surveys including the HCAHPS survey often fail to ask patients directly about their perceptions of safety. In fact, this study and others20, 21 show that patients are able to recognize adverse events during hospitalization. Patient report may be a useful adjunct to other methods of adverse event case finding and outcomes reporting.

Second, while HCAHPS and others identify warmth, courtesy, concern, and respect as dimensions of patient‐centered care,14, 17, 22, 23 the ability of quantitative satisfaction surveys to capture the experience of disrespectful treatment may be limited, especially during hospitalization. Most respondents who commented on feeling disrespected identified only a single encounter, which can be masked by otherwise satisfying interactions with numerous care providers. Directly asking patients whether any experience during hospitalization caused them to feel disrespected, and allowing room for explanation, might more efficiently identify problem areas. This is particularly important because even one episode of disrespectful treatment, particularly when perceived to be racially motivated, increases the likelihood of not following a doctor's advice or putting off care.24

Third, HCAHPS emphasizes two aspects of communication: that between patients and doctors, and that between patients and nurses. Our patients confirmed that these are important, but they also noted a third dimension of communication contributing to dissatisfaction: provider‐provider communication. Communication and coordination failures among providers are key contributors to adverse events or near misses,2528 but their influence on patient satisfaction has not been widely assessed. Furthermore, patient input is rarely utilized to identify poor interprovider communication. Our study suggests that, just as patients can identify adverse events, they are also able to recognize poor provider‐provider communication.

Patients' reports of dissatisfying events also highlight areas in which small changes in hospital practice might greatly improve the patient experience. For instance, concerns over environment, food, sleep, hygiene, and pain appeared to be representative of a broader dissatisfaction with loss of autonomy and control. Hospitalized patients are often obliged to room with strangers, are subject to noise and interruptions, and cede control of their medication management at a time when they are feeling particularly vulnerable. The importance of this lack of autonomy to patients suggests a variety of small interventions that could improve satisfaction, such as individual control of noise and temperature, a visible commitment to a quiet hospital environment, and minimized interruptions and sleep disturbance.2932 Single‐occupancy hospital rooms have been associated with lower rates of nosocomial infection, medication errors, and patient stress, as well as increased privacy, rest, visitor involvement, and doctor‐patient communication.33, 34 The most sophisticated intervention, acuity‐adaptable private hospital rooms, allows hospitals to maintain patients in the same private hospital room during an entire admission, regardless of changes to level of acuity.35

In‐depth analysis of suggestions for improvement, as gathered by telephone surveys of recently discharged patients, was a particularly well‐suited approach to identifying explicit expectations for care that were violated by dissatisfying incidents. When allowed to express dissatisfaction in terms of suggestions for improvement, patients talked freely about specific dissatisfying experiences. Using telephone interviews allowed a large volume of patient responses to be included, unlike smaller focus groups. Our study was oral and did not rely on the literacy level of patients. Additionally, the open‐ended nature of questioning avoided some of the usual pitfalls of satisfaction surveys. We did not rely on predetermined satisfaction categories or presume the inherent value of particular attributes of care. Nonetheless, our study does have important limitations.

Patient perceptions were not compared with chart data or clinician report. Caregivers were allowed to participate in lieu of patients, which may have reduced identification of some dissatisfying events. Likewise, patients discharged to nursing homes or who were not English or Spanish speaking were excluded and may have had different dissatisfying experiences. Interviews were brief and dissatisfying events were not explored in detail. Although nearly half of respondents reported dissatisfying events, some patients may have been reluctant to criticize their care directly to a hospital representative. Finally, patients generally confined their comments to one or two dissatisfying events, even though there may have been others. We therefore cannot draw any conclusions about the relative frequency of dissatisfying events by domain.

Conclusions

All hospitalized patients bring expectations for their hospital experience. While specific expectations vary between patients, expectations for: 1) safety, 2) treatment with respect and dignity, 3) prompt and efficient care, 4) successful exchange of information, 5) environmental autonomy and control, and 6) high‐quality amenities were found in this study to encompass core expectations for hospitalization. It may be useful to ensure that postdischarge surveys explicitly address these expectations. Efforts to address and manage these core expectations of hospital care may help to reduce patient dissatisfaction with hospitalization and improve the delivery and quality of hospital care.

The United States spends more money per capita on healthcare than any other industrialized nation,1 yet patients are the least satisfied with their care.2 Patient satisfaction is associated in both cross‐sectional3 and longitudinal studies4 with improved physical and mental health outcomes. Conversely, dissatisfaction with care hampers future medical interactions, prevents sharing of information, and impairs the building of trust.5 The increasing recognition that a patient's experience of care affects patient outcomes has furthered efforts to evaluate satisfaction with care.6, 7

However, patient satisfaction is challenging to define and understand. Even the definition of satisfaction is ambiguous, for to satisfy can mean both to make happy and the lesser, to be adequate. To dissatisfy is to displease or disappoint, but dissatisfaction is not the opposite of satisfaction: qualitative studies give little if any indication that patients evaluate satisfaction on a continuum ranging from dissatisfied at one end to very satisfied at the other.8 Instead, it appears that satisfaction and dissatisfaction are different constructs, such that patients may simultaneously be both satisfied and dissatisfied.9, 10 Patients often express overall satisfaction with a service or encounter while also reporting specific criticisms about its shortcomings.11, 12 Alternatively, consumers may be generally satisfied unless something unpleasant or improper happens.13 Thus, dissatisfaction and satisfaction may require different methods of measurement.

The most common model for measuring patient satisfaction is a quantitative survey of patients' experiences in specific predetermined domains. Of 54 hospital satisfaction surveys in common use, only 11 included patient input in their development,14 casting doubt on the relevance of these attributes to patients' priorities of care. Since it is well recognized that patient expectations influence satisfaction,8, 13, 15 it is important to identify patient expectations and priorities up front. However, these have not been clearly established. Furthermore, focusing purely on satisfaction with particular domains of care may miss the separate but illuminating construct of patient dissatisfaction.

In this study we therefore aim to understand patient dissatisfaction with hospitalization more fully as a means of elucidating implicit expectations for hospital care. Using qualitative techniques, we analyzed a large volume of patient responses to a single open‐ended study question to identify determinants and patterns of patient dissatisfaction.

Methods

Results

A total of 976 surveys was randomly selected from 9,764 postdischarge phone interviews completed between July 1, 2007 and June 30, 2008. A total of 56.3% of patients was female. Nearly half the patients were discharged from medical units (Table 1). Of the 976 patients, 439 (45.0%) gave at least one suggestion for improvement, yielding a total of 579 suggestions. Patients also offered numerous positive comments about their care, but these comments were not included in the analysis.

Through qualitative analysis, we assigned suggestions for improvement to six major categories of dissatisfaction: 1) ineptitude, 2) disrespect, 3) prolonged waits, 4) ineffective communication, 5) lack of environmental control, and 6) substandard amenities. We considered the inverse of these problems to represent six implicit expectations of good hospital care: 1) safety, 2) treatment with respect and dignity, 3) prompt and efficient care, 4) successful exchange of information, 5) environmental autonomy and control, and 6) high‐quality amenities (Table 2). The number of patient suggestions related to each domain is detailed in Table 3.

Discussion

We analyzed 439 patient suggestions for improving hospital care and found that dissatisfaction resulted from six categories of negative experiences: 1) ineptitude, 2) disrespect, 3) prolonged wait times, 4) ineffective communication, 5) lack of environmental control, and 6) substandard amenities. These domains represented a corresponding set of implicit patient expectations for: 1) safety, 2) treatment with respect and dignity, 3) prompt and efficient care, 4) successful exchange of information, 5) environmental autonomy and control, and 6) high‐quality amenities. Each of these categories suggests avenues by which both the assessment and provision of hospital care can be made more patient‐centered.

The most widely used patient satisfaction survey in use in the United States today is the Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS), which includes eight domains: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment.17 The dissatisfaction domains found in this study closely overlap the HCAHPS satisfaction domains, but with a few key differences.

First, dissatisfaction with ineptitude in our study encompassed concerns over adverse events and near misses, in addition to the cleanliness of the environment. Other research has shown that dissatisfaction with hospitalization can be predicted by the number of reported problems18 and the perception of receiving incorrect treatment.19 While elaborate methods have been devised to assess and compare the hospital quality and safety, patient satisfaction surveys including the HCAHPS survey often fail to ask patients directly about their perceptions of safety. In fact, this study and others20, 21 show that patients are able to recognize adverse events during hospitalization. Patient report may be a useful adjunct to other methods of adverse event case finding and outcomes reporting.

Second, while HCAHPS and others identify warmth, courtesy, concern, and respect as dimensions of patient‐centered care,14, 17, 22, 23 the ability of quantitative satisfaction surveys to capture the experience of disrespectful treatment may be limited, especially during hospitalization. Most respondents who commented on feeling disrespected identified only a single encounter, which can be masked by otherwise satisfying interactions with numerous care providers. Directly asking patients whether any experience during hospitalization caused them to feel disrespected, and allowing room for explanation, might more efficiently identify problem areas. This is particularly important because even one episode of disrespectful treatment, particularly when perceived to be racially motivated, increases the likelihood of not following a doctor's advice or putting off care.24

Third, HCAHPS emphasizes two aspects of communication: that between patients and doctors, and that between patients and nurses. Our patients confirmed that these are important, but they also noted a third dimension of communication contributing to dissatisfaction: provider‐provider communication. Communication and coordination failures among providers are key contributors to adverse events or near misses,2528 but their influence on patient satisfaction has not been widely assessed. Furthermore, patient input is rarely utilized to identify poor interprovider communication. Our study suggests that, just as patients can identify adverse events, they are also able to recognize poor provider‐provider communication.

Patients' reports of dissatisfying events also highlight areas in which small changes in hospital practice might greatly improve the patient experience. For instance, concerns over environment, food, sleep, hygiene, and pain appeared to be representative of a broader dissatisfaction with loss of autonomy and control. Hospitalized patients are often obliged to room with strangers, are subject to noise and interruptions, and cede control of their medication management at a time when they are feeling particularly vulnerable. The importance of this lack of autonomy to patients suggests a variety of small interventions that could improve satisfaction, such as individual control of noise and temperature, a visible commitment to a quiet hospital environment, and minimized interruptions and sleep disturbance.2932 Single‐occupancy hospital rooms have been associated with lower rates of nosocomial infection, medication errors, and patient stress, as well as increased privacy, rest, visitor involvement, and doctor‐patient communication.33, 34 The most sophisticated intervention, acuity‐adaptable private hospital rooms, allows hospitals to maintain patients in the same private hospital room during an entire admission, regardless of changes to level of acuity.35

In‐depth analysis of suggestions for improvement, as gathered by telephone surveys of recently discharged patients, was a particularly well‐suited approach to identifying explicit expectations for care that were violated by dissatisfying incidents. When allowed to express dissatisfaction in terms of suggestions for improvement, patients talked freely about specific dissatisfying experiences. Using telephone interviews allowed a large volume of patient responses to be included, unlike smaller focus groups. Our study was oral and did not rely on the literacy level of patients. Additionally, the open‐ended nature of questioning avoided some of the usual pitfalls of satisfaction surveys. We did not rely on predetermined satisfaction categories or presume the inherent value of particular attributes of care. Nonetheless, our study does have important limitations.

Patient perceptions were not compared with chart data or clinician report. Caregivers were allowed to participate in lieu of patients, which may have reduced identification of some dissatisfying events. Likewise, patients discharged to nursing homes or who were not English or Spanish speaking were excluded and may have had different dissatisfying experiences. Interviews were brief and dissatisfying events were not explored in detail. Although nearly half of respondents reported dissatisfying events, some patients may have been reluctant to criticize their care directly to a hospital representative. Finally, patients generally confined their comments to one or two dissatisfying events, even though there may have been others. We therefore cannot draw any conclusions about the relative frequency of dissatisfying events by domain.

Conclusions

All hospitalized patients bring expectations for their hospital experience. While specific expectations vary between patients, expectations for: 1) safety, 2) treatment with respect and dignity, 3) prompt and efficient care, 4) successful exchange of information, 5) environmental autonomy and control, and 6) high‐quality amenities were found in this study to encompass core expectations for hospitalization. It may be useful to ensure that postdischarge surveys explicitly address these expectations. Efforts to address and manage these core expectations of hospital care may help to reduce patient dissatisfaction with hospitalization and improve the delivery and quality of hospital care.

The United States spends more money per capita on healthcare than any other industrialized nation,1 yet patients are the least satisfied with their care.2 Patient satisfaction is associated in both cross‐sectional3 and longitudinal studies4 with improved physical and mental health outcomes. Conversely, dissatisfaction with care hampers future medical interactions, prevents sharing of information, and impairs the building of trust.5 The increasing recognition that a patient's experience of care affects patient outcomes has furthered efforts to evaluate satisfaction with care.6, 7

However, patient satisfaction is challenging to define and understand. Even the definition of satisfaction is ambiguous, for to satisfy can mean both to make happy and the lesser, to be adequate. To dissatisfy is to displease or disappoint, but dissatisfaction is not the opposite of satisfaction: qualitative studies give little if any indication that patients evaluate satisfaction on a continuum ranging from dissatisfied at one end to very satisfied at the other.8 Instead, it appears that satisfaction and dissatisfaction are different constructs, such that patients may simultaneously be both satisfied and dissatisfied.9, 10 Patients often express overall satisfaction with a service or encounter while also reporting specific criticisms about its shortcomings.11, 12 Alternatively, consumers may be generally satisfied unless something unpleasant or improper happens.13 Thus, dissatisfaction and satisfaction may require different methods of measurement.

The most common model for measuring patient satisfaction is a quantitative survey of patients' experiences in specific predetermined domains. Of 54 hospital satisfaction surveys in common use, only 11 included patient input in their development,14 casting doubt on the relevance of these attributes to patients' priorities of care. Since it is well recognized that patient expectations influence satisfaction,8, 13, 15 it is important to identify patient expectations and priorities up front. However, these have not been clearly established. Furthermore, focusing purely on satisfaction with particular domains of care may miss the separate but illuminating construct of patient dissatisfaction.

In this study we therefore aim to understand patient dissatisfaction with hospitalization more fully as a means of elucidating implicit expectations for hospital care. Using qualitative techniques, we analyzed a large volume of patient responses to a single open‐ended study question to identify determinants and patterns of patient dissatisfaction.

Methods

Results

A total of 976 surveys was randomly selected from 9,764 postdischarge phone interviews completed between July 1, 2007 and June 30, 2008. A total of 56.3% of patients was female. Nearly half the patients were discharged from medical units (Table 1). Of the 976 patients, 439 (45.0%) gave at least one suggestion for improvement, yielding a total of 579 suggestions. Patients also offered numerous positive comments about their care, but these comments were not included in the analysis.

Through qualitative analysis, we assigned suggestions for improvement to six major categories of dissatisfaction: 1) ineptitude, 2) disrespect, 3) prolonged waits, 4) ineffective communication, 5) lack of environmental control, and 6) substandard amenities. We considered the inverse of these problems to represent six implicit expectations of good hospital care: 1) safety, 2) treatment with respect and dignity, 3) prompt and efficient care, 4) successful exchange of information, 5) environmental autonomy and control, and 6) high‐quality amenities (Table 2). The number of patient suggestions related to each domain is detailed in Table 3.

Discussion

We analyzed 439 patient suggestions for improving hospital care and found that dissatisfaction resulted from six categories of negative experiences: 1) ineptitude, 2) disrespect, 3) prolonged wait times, 4) ineffective communication, 5) lack of environmental control, and 6) substandard amenities. These domains represented a corresponding set of implicit patient expectations for: 1) safety, 2) treatment with respect and dignity, 3) prompt and efficient care, 4) successful exchange of information, 5) environmental autonomy and control, and 6) high‐quality amenities. Each of these categories suggests avenues by which both the assessment and provision of hospital care can be made more patient‐centered.

The most widely used patient satisfaction survey in use in the United States today is the Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS), which includes eight domains: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment.17 The dissatisfaction domains found in this study closely overlap the HCAHPS satisfaction domains, but with a few key differences.

First, dissatisfaction with ineptitude in our study encompassed concerns over adverse events and near misses, in addition to the cleanliness of the environment. Other research has shown that dissatisfaction with hospitalization can be predicted by the number of reported problems18 and the perception of receiving incorrect treatment.19 While elaborate methods have been devised to assess and compare the hospital quality and safety, patient satisfaction surveys including the HCAHPS survey often fail to ask patients directly about their perceptions of safety. In fact, this study and others20, 21 show that patients are able to recognize adverse events during hospitalization. Patient report may be a useful adjunct to other methods of adverse event case finding and outcomes reporting.

Second, while HCAHPS and others identify warmth, courtesy, concern, and respect as dimensions of patient‐centered care,14, 17, 22, 23 the ability of quantitative satisfaction surveys to capture the experience of disrespectful treatment may be limited, especially during hospitalization. Most respondents who commented on feeling disrespected identified only a single encounter, which can be masked by otherwise satisfying interactions with numerous care providers. Directly asking patients whether any experience during hospitalization caused them to feel disrespected, and allowing room for explanation, might more efficiently identify problem areas. This is particularly important because even one episode of disrespectful treatment, particularly when perceived to be racially motivated, increases the likelihood of not following a doctor's advice or putting off care.24

Third, HCAHPS emphasizes two aspects of communication: that between patients and doctors, and that between patients and nurses. Our patients confirmed that these are important, but they also noted a third dimension of communication contributing to dissatisfaction: provider‐provider communication. Communication and coordination failures among providers are key contributors to adverse events or near misses,2528 but their influence on patient satisfaction has not been widely assessed. Furthermore, patient input is rarely utilized to identify poor interprovider communication. Our study suggests that, just as patients can identify adverse events, they are also able to recognize poor provider‐provider communication.

Patients' reports of dissatisfying events also highlight areas in which small changes in hospital practice might greatly improve the patient experience. For instance, concerns over environment, food, sleep, hygiene, and pain appeared to be representative of a broader dissatisfaction with loss of autonomy and control. Hospitalized patients are often obliged to room with strangers, are subject to noise and interruptions, and cede control of their medication management at a time when they are feeling particularly vulnerable. The importance of this lack of autonomy to patients suggests a variety of small interventions that could improve satisfaction, such as individual control of noise and temperature, a visible commitment to a quiet hospital environment, and minimized interruptions and sleep disturbance.2932 Single‐occupancy hospital rooms have been associated with lower rates of nosocomial infection, medication errors, and patient stress, as well as increased privacy, rest, visitor involvement, and doctor‐patient communication.33, 34 The most sophisticated intervention, acuity‐adaptable private hospital rooms, allows hospitals to maintain patients in the same private hospital room during an entire admission, regardless of changes to level of acuity.35

In‐depth analysis of suggestions for improvement, as gathered by telephone surveys of recently discharged patients, was a particularly well‐suited approach to identifying explicit expectations for care that were violated by dissatisfying incidents. When allowed to express dissatisfaction in terms of suggestions for improvement, patients talked freely about specific dissatisfying experiences. Using telephone interviews allowed a large volume of patient responses to be included, unlike smaller focus groups. Our study was oral and did not rely on the literacy level of patients. Additionally, the open‐ended nature of questioning avoided some of the usual pitfalls of satisfaction surveys. We did not rely on predetermined satisfaction categories or presume the inherent value of particular attributes of care. Nonetheless, our study does have important limitations.

Patient perceptions were not compared with chart data or clinician report. Caregivers were allowed to participate in lieu of patients, which may have reduced identification of some dissatisfying events. Likewise, patients discharged to nursing homes or who were not English or Spanish speaking were excluded and may have had different dissatisfying experiences. Interviews were brief and dissatisfying events were not explored in detail. Although nearly half of respondents reported dissatisfying events, some patients may have been reluctant to criticize their care directly to a hospital representative. Finally, patients generally confined their comments to one or two dissatisfying events, even though there may have been others. We therefore cannot draw any conclusions about the relative frequency of dissatisfying events by domain.

Conclusions

All hospitalized patients bring expectations for their hospital experience. While specific expectations vary between patients, expectations for: 1) safety, 2) treatment with respect and dignity, 3) prompt and efficient care, 4) successful exchange of information, 5) environmental autonomy and control, and 6) high‐quality amenities were found in this study to encompass core expectations for hospitalization. It may be useful to ensure that postdischarge surveys explicitly address these expectations. Efforts to address and manage these core expectations of hospital care may help to reduce patient dissatisfaction with hospitalization and improve the delivery and quality of hospital care.