OBJECTIVES: Patient satisfaction consists of a complex multitude of composite factors including perceived needs, expectations, and holistic experience within a healthcare system that are challenging to measure. We aimed to test the effectiveness of a customer satisfaction quality measurement models for its effectiveness in improving services in primary healthcare (PHC) settings.

METHODS: We conducted a qualitative synthesis of the literature adhering to ENTREQ guidelines and utilized PubMed/Medline, EMBASE, and Google Scholar databases to evaluate the use of customer service models in PHC service improvement. No setting, time, or language restrictions were applied.

RESULTS: In our qualitative synthesis, we included 24 studies. Of these, 16 examined the Kano model, which classified one-dimensional, attractive, and indifferent attributes on patient questionnaires. These studies focused category prioritization and targeting interventions based on cost-effect analysis and stratified management of identified limitations. Other modeling techniques as quality function deployment (QFD) matrices, Servqual, analytic hierarchy process, customer satisfaction matrices, and/or service blueprints were also combined or compared in the majority of included studies. Several studies utilized Kano-QFD matrices to quantify and target customer’s priorities and ensure their satisfaction. This combination was suggested to enhance attractive service attributes and facilitate service innovation and delivery. Other studies suggested the ineffectiveness of the Kano-QFD model on its own but added benefits when combined with calculated satisfaction indices among other techniques in healthcare settings. We determined that safety, infrastructure, and facility management are critical factors in operation and patient confidence in the facility, particularly low-resource and rural facilities, where implementing evaluations are more challenging.

CONCLUSIONS: Patient service quality depends on must-be and essential one-dimensional attributes being delivered first. A complex interplay of factors determine the patient satisfaction and each assessment method had major limitations, indicating the ongoing need for consistent patient experience monitoring, especially amidst the pandemic.