text: As an expert in customer experience, I too am concerned with the approach used to define patient satisfaction and the linkage of that to healthcare funding. However, I think there has to be a clear distinction in future studies.
  When we (my company http://www.tonybodoh.com) have worked with medical practices (not hospitals) we have examined the differences in the commentary attached to patient reviews. Going beyond “satisfaction” we study what themes correlate with higher or lower satisfaction. And, some of what we’ve found could support the findings of this study: Some, but certainly not all, of the commentary of low rated reviews are a result of the patient not believing the diagnosis of the doctor. They therefore seek out another doctor to get the medical attention they were initially seeking with the first doctor. Is it possible that the patient satisfaction studies need to take a longitudinal approach to see if the dissatisfied patients sought treatment elsewhere and therefore their additional treatment is not included in hospital records? Is it possible that these dissatisfied patients had evidence that what they were not being evaluated sufficiently? These questions are still unanswered as far as I can tell.