Do satisfied employees lead to satisfied patients? An empirical study in an Italian hospital
Journal article, 2016

This study aimed to understand the relationship between care provider (employee) satisfaction and patient satisfaction and to identify key drivers of their satisfaction. The EFQM-based 4P model and Picker’s Patient Experience quality dimension were used as the theoretical basis for understanding the satisfaction relationship along with the key drivers. A cross-sectional survey was conducted in two wards (maternity and cardiology) from June to August 2014. The partial least squares structural equation modelling (PLS-SEM) method was used to analyze the data. For the 4P model, we found strong evidence for the influence of enablers on the results and eventually on employee satisfaction. Likewise, we found strong evidence for the effect of patients’ experience on their overall satisfaction and eventually on their loyalty. Concerning the relationship between employee and patient satisfaction, we found that a higher patient satisfaction level in one ward was associated with higher employee satisfaction in the same ward. Other findings include the identification of key drivers of patient and employee satisfaction along with improvement priorities for each ward. This study provides insights that can be useful for healthcare managers and policymakers responsible for developing and planning strategies for more sustainable healthcare organizations.

4P excellence model

Quality in healthcare

Picker’s questionnaire

customer satisfaction

partial least squares


Hendry Raharjo

Chalmers, Technology Management and Economics, Service Management and Logistics

Roberta Guglielmetti Mugion

Universita degli studi - Roma Tre

Laura Di Pietro

Universita degli studi - Roma Tre

Martina Toni

Universita degli studi - Roma Tre

Total Quality Management and Business Excellence

1478-3363 (ISSN) 1478-3371 (eISSN)

Vol. 27 7-8 853-874

Subject Categories

Production Engineering, Human Work Science and Ergonomics

Health Care Service and Management, Health Policy and Services and Health Economy

Applied Psychology

Business Administration

Probability Theory and Statistics

Driving Forces

Sustainable development

Areas of Advance




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