Administration of Emergency Medicine| Volume 41, ISSUE 6, P686-692, December 2011

Framework for Analyzing Wait Times and Other Factors that Impact Patient Satisfaction in the Emergency Department



      Wait times and patient satisfaction are important administrative metrics in emergency departments (EDs), as they are critical to return patronage, liability, and remuneration. Although several factors have been shown to impact patient satisfaction, little attention has been paid to understanding the psychology of waiting and patient satisfaction.


      We utilize concepts that have been applied in other service industries to conceptualize factors that impact patient satisfaction. We focus on wait times, a key factor in patient satisfaction, and describe how these concepts can be applied in research and daily practice.


      Patient satisfaction can be conceptualized as the difference between a patient’s perceptions and their expectations. Perception is the psychological process by which an individual understands and interprets sensory information. Changes in the wait experience can decrease the perceived wait times without a change in actual wait times. Other changes such as improved staff interpersonal and communication skills that provide patients with an increased sense of the staff’s dedication as well as a greater understanding of their care, can also affect patient perceptions of their care quality. These changes in patient perception can synergize with more expensive investments such as state-of-the-art facilities and increased ED beds to magnify their impact on patient satisfaction. Expectation is the level of service a patient believes they will receive during their ED visit. Patients arrive with expectations around the component of their care such as wait times, needed diagnostic tests, and overall time in the ED. These expectations are affected by individual-specific, pre-encounter, and intra-encounter factors. When these factors are identified and understood, they can be managed during the care process to improve patient satisfaction.


      Interventions to decrease perception of wait times and increase the perception of service being provided, when combined with management of patient expectations, can improve patient satisfaction.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Asplin B.R.
        • Magid D.J.
        • Rhodes K.V.
        • et al.
        A conceptual model of emergency department crowding.
        Ann Emerg Med. 2003; 42: 173-180
        • Anderson E.W.
        • Sullivan M.W.
        The antecedents and consequences of customer satisfaction for firms.
        Mark Sci. 1993; 12: 125-143
        • Anderson E.W.
        • Fornell C.
        • Lehmann D.R.
        Customer satisfaction, market share, and profitability: findings from Sweden.
        J Mark. 1994; 58: 53-66
        • Bolton R.N.
        A dynamic model of the duration of customer’s relationship with a continuous service provider: the role of satisfaction.
        Mark Sci. 1998; 18: 45-65
        • Ley P.
        Satisfaction, compliance, and communication.
        Br J Clin Psychol. 1982; 21: 241-254
        • Forster H.P.
        • Schwartz J.
        • DeRenzo E.
        Reducing legal risk by practicing patient-centered medicine.
        Arch Intern Med. 2002; 162: 1217-1219
      1. Stawiski S, Bavin S, Fulton B. The impact of patient satisfaction on pay-for-performance in medical practices. Available at: Accessed August 1, 2009.

        • Boudreaux E.D.
        • O’Hea E.L.
        Patient satisfaction in the emergency department: a review of the literature and implications for practice.
        J Emerg Med. 2004; 26: 13-26
      2. Maister DH. The psychology of waiting lines. Available at: Accessed July 7, 2009.

        • Baker J.
        • Cameron M.
        The effects of the service environment on affect and customer perception of waiting time: an integrative review and research propositions.
        J Acad Mark Sci. 1996; 24: 338-349
        • Rafaeli A.
        • Barron G.
        • Haber K.
        The effects of queue structure on attitudes.
        J Serv Res. 2002; 5: 125-139
        • Brown T.
        • Cranier S.
        • Deariove D.
        • Rodrigez J.N.
        “David Maister” in business minds: connect with the world's greatest management thinkers.
        Prentice Hall, New York2002
        • Engel K.G.
        • Heisler M.
        • Smith D.M.
        • et al.
        Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand?.
        Ann Emerg Med. 2009; 54: 454-461
        • William S.
        • Weinman J.
        • Dale J.
        Doctor-patient communication and patient satisfaction: a review.
        Fam Pract. 1998; 15: 480-492
      3. Viccellio P, Schneider SM, Asplin B, et al. Emergency department crowding: high-impact solutions. American College of Emergency Website. Available at: Accessed July 7, 2009.

        • Thompson D.A.
        • Yarnold P.R.
        • Adams S.L.
        • Spacone A.B.
        How accurate are waiting time perceptions of patients in the emergency department?.
        Ann Emerg Med. 1996; 28: 652-656
        • Katz K.
        • Larson B.
        • Larson R.
        Prescription for the waiting in line blues: entertain, enlighten and engage.
        Sloan Manag Rev. 1991; : 44-53
        • Martin A.P.
        Think proactive: new insights in decision-making.
        Professional Development Institute, Ottawa, Canada1983
      4. Pawlowski A. Queuing psychology: can waiting in line be fun? CNN website. Available at: Accessed July 7, 2009.

      5. Press Ganey. Emergency Department Pulse Report 2009. Available at: Accessed August 1, 2009.

        • Wiler J.L.
        • Gentle C.
        • Halfpenny J.M.
        • et al.
        Optimizing emergency department front-end operations.
        Ann Emerg Med. 2010; 55: 142-160
      6. Miller JA. Studying satisfaction, modifying models, eliciting expectations, posing problems, and making meaningful measurements. In: Hunt HK, ed. Conceptualization and measurement of consumer satisfaction and dissatisfaction. Cambridge, MA: Marketing Science Institute; 1977:72–91.

        • Boulding W.
        • Kalra A.
        • Staelin R.
        • et al.
        A dynamic process model of service quality: from expectations to behavioral intentions.
        J Mark Res. 1993; 30: 7-27
        • Hamer L.O.
        • Liu B.S.
        • Sudharshan D.
        The effects of intraencounter changes in expectations on perceived service quality models.
        J Serv Res. 1999; 1: 275-289
        • Zeithaml V.A.
        • Berry L.L.
        • Parasuraman A.
        The nature and determinants of customer expectations of service.
        J Acad Mark Sci. 1993; 21: 1-12