Empirical Examination of the Interactions Between Healthcare Professionals and Patients Within Hospital Environments—A Pilot Study

Abstract

Patients represent the primary stakeholders in health systems, making it crucial to enhance their level of satisfaction. The relationship between physician and patient is crucial during treatment, especially for patients dealing with long-term issues. Generally, every illness has the potential to cause high levels of stress, leading to varying reactions from individuals, influenced by factors such as age, personality, relationships with caregivers, treatment environment, and specific disease characteristics. As the healthcare provider acquires a more profound insight into how the disease affects the patient’s quality of life, the relationship between the patient and the physician evolves. In this study, we analyzed information from hospital clinics that took part in the survey for the same timeframe, from July 2019 to December 2020. Correlated data were derived from two separate surveys. The initial survey, created by Spector, focused on gathering feedback from health professionals in hospitals, with 3278 responses collected. A second survey was designed to gather feedback from patients in hospitals, with 2851 responses collected. The survey revealed a total of 97 common observations among physicians and patients in the hospital clinics. According to the findings from the two-stage least squares (2SLS) regression analysis, an essential method for researchers addressing endogeneity challenges in structural equation modeling, an increase of 1 point in the job satisfaction of physicians is associated with a corresponding positive increase of 1.12 points in patient satisfaction. At the heart of effective healthcare is the relationship between physicians and patients. Positive attitudes from patients during medical appointments help improve health outcomes, especially for those with long-term illnesses. In order to encourage patients to take an active role, physicians need to focus on enhancing the physician-patient bond, humaneness, creating trust and stable communication, encouraging the sharing of information, and empowering patients to participate in decision-making.

1. Introduction

Healthcare professional satisfaction pertains to the degree of contentment experienced by employees within healthcare organizations, influenced by their roles, status, and positions. In a related context, patient satisfaction can be understood as the extent to which individuals are pleased with the products or services that they receive, reflecting their assessment of the quality of offerings from healthcare providers. Prior studies have consistently demonstrated a positive correlation between the satisfaction levels of healthcare professionals and patient satisfaction, alongside the quality of the healthcare services delivered [1].

Job satisfaction among employees tends to increase when they experience favorable working circumstances with a supportive and equitable management approach. Job satisfaction arises from a multifaceted interaction of numerous elements, which can generally be classified into personal and demographic traits, management-related factors, and workplace or environmental influences. These elements encompass a range of considerations, including fair compensation, suitable staffing levels, a nurturing work atmosphere, opportunities for personal and professional growth, manageable work demands, inspiring leadership, recognition of contributions, support for favorable patient care results, robust peer relationships, autonomy in the workplace, job security, and advancement based on merit [2,3,4]. Dissatisfaction, on the other hand, is associated with challenging work conditions and overwhelming workloads, which may result in diminished employee loyalty to the organization. This absence of satisfaction and loyalty can negatively influence employees’ performance, jeopardize the quality of care, diminish productivity, and may even prompt individuals to seek employment opportunities elsewhere, resulting in increased staff turnover rates. This phenomenon can negatively affect the health sector, resulting in the loss of seasoned personnel, unexpected staff reallocations, and the necessity for new hires, all of which contribute to rising associated costs. Hence, according to Atkins et al. (1996), dissatisfaction among employees detrimentally influences the quality and continuity of care, which ultimately undermines patient loyalty and, consequently, the hospital’s reputation and patient retention [5].

Measuring the quality of and satisfaction with healthcare constitutes a key element in the adequate management of resources, allowing for a focus on the preferences of users, giving them the opportunity to create a personalized health service that is better adapted to their expectations and needs. In the past 10 years, patients have increasingly raised their expectations of healthcare providers, seeking higher standards of care and service. As a result, patient satisfaction can provide utility in the structure of evaluations related to in-hospital care, patient judgments, organizational management, and organizational loyalty. When discussing public hospitals or healthcare institutions, it may appear that there is little financial incentive to conduct research, as these entities are not primarily profit-driven. Nevertheless, the government, in its role of implementing social policy, allocates resources to health services that could be redirected to alternative initiatives and projects. The decisions made in this regard are subject to evaluation by citizens and local communities. Importantly, a significant causal link exists between the quality of healthcare and patient satisfaction. Research indicates that satisfied patients tend to adhere more closely to treatment regimens, exhibit a greater willingness to engage in educational opportunities, and ultimately achieve improved health outcomes. Since the treatment process is based on the active participation of the patient and good communication with the physician, monitoring satisfaction may help identify cases of poor collaboration between the two. This assessment enables a focus on user preferences, allowing for the development of personalized health services that align more closely with patients’ expectations and needs. The effectiveness and long-term success of healthcare organizations depend heavily on the quality of healthcare services and the satisfaction of patients. Many studies report the existence of positive results from the relationship that develops between patient satisfaction and healthcare personnel. On the other hand, in many cases, patients are not satisfied with the provision of infrastructure, especially in Greek public hospitals in the last decade, as result of the long-term economic crisis and Covid-19 pandemic. This fact highlights the special role of medical and nursing personnel as a key “pillar” in forming a favorable impression of overall healthcare services [6,7,8].

The structure of this paper is outlined as follows: Section 2 will provide an in-depth discussion of the theoretical framework and its adaptations to align with the objectives of this study. In Section 3, the research methodology employed will be detailed. Section 4 will present the findings and their corresponding analysis. Section 5 describes the limitations and prospects for future research, while Section 6 contextualizes the results in relation to the paper’s aims. Finally, Section 7 will underscore this paper’s contributions.

2. Theoretical Background and Research Hypotheses

Several researchers categorize the primary users of health service systems into two main groups: (a) internal (employees) and (b) external (including patients, patients’ families, and society). The needs of the users must be examined separately–that is, not only the needs of the patients, but also those of the employees. Indeed, the emphasis is placed on the fact that if an organization cannot satisfy the needs of its employees, it will probably never be able to satisfy its patients.

A significant body of research has sought to investigate the connection between employee satisfaction and patient satisfaction. In their 1991 study, Bolton and Drew suggested that job satisfaction has a consistent impact on patients’ perceptions of the quality of healthcare services provided. This connection significantly influences the overall quality of these services, which subsequently affects patient satisfaction. In 1994, Heskett et al. posited that the connection between healthcare professionals and patient satisfaction is directly related to overall satisfaction, a claim that was subsequently validated by Singh and Sirdeshmukh (2000). Xu and Goedegebuure (2005) found a positive relationship between employee satisfaction and patient satisfaction. Conversely, Oh and Yoon (2011) argued that job satisfaction in service industries plays a crucial role in determining service quality, which, in turn, influences user satisfaction. Finally, the literature indicates that when professionals have strong motivation, power, and cooperation, they show correspondingly high levels of interest and motivation, with the consequent creation of high levels of patient satisfaction. Rehaman and Husnain (2018) established a connection between patient satisfaction and employee satisfaction within the context of quality care. Their research further indicated that various aspects of employee behavior contribute to patient satisfaction. Notable factors included empathy, characterized by a caring attitude and personalized attention, as well as the professional appearance of healthcare providers [9,10,11,12,13,14,15,16]. The primary concern identified in the aforementioned studies was the challenge of aligning patients with the appropriate physicians. In essence, most of these studies focused on overall patient satisfaction within a hospital setting that employs multiple physicians.

The preceding analysis reveals that numerous researchers have explored the factors that affect the quality of healthcare services and patient satisfaction. However, there is a significant lack of studies focusing on the impact of healthcare provider satisfaction on patient satisfaction, highlighting a substantial gap in the existing literature. Therefore, the main research question would be as follows: Do satisfied healthcare professionals, including physicians and nursing personnel, enhance patient satisfaction?

To answer the main problem, a provisional answer is given in the form of the following hypotheses:

Hypothesis 1 (H1): 

The connection between healthcare professionals and patients can be measured, allowing for the creation of an indicator to evaluate how the satisfaction of healthcare personnel influences patient satisfaction. 

Hypothesis 2 (H2): 

Increased job satisfaction among healthcare professionals results in enhanced patient satisfaction. 

Hypothesis 3 (H3): 

The effectiveness of this impact is influenced by the robustness of the physician–patient relationship. 

3. Materials and Methods

3.1. Instruments

Two separate, structured, and validated questionnaires were employed, specifically designed to address this study’s objectives in gathering data on professionals’ perceptions of job satisfaction and the experiences of inpatients. The first tool utilized was the Job Satisfaction Survey (JSS), developed by Spector, which aims to evaluate the satisfaction levels of healthcare professionals within 13 public hospital settings. The survey was conducted from July 2019 to October 2020 and comprised a 36-item questionnaire assessed through a Likert scale, organized into nine distinct dimensions. Additionally, supplementary questions were included to gather information on demographic and socio-economic variables [17,18]. The survey achieved a response rate of 81.95%, resulting in 3278 completed questionnaires. Among these, 52.96% (N = 1736) were completed by nursing personnel, 24.50% (N = 803) by medical staff, and 22.54% (N = 739) by other healthcare professionals. To assess employee satisfaction levels, the mean percentage scores of both positive and negative responses were calculated. The overall average job satisfaction was found to be moderate, with a score of 3.33 out of 6. The area with the lowest satisfaction was salaries, which received a score of 2.12. Additionally, the domains related to promotions (2.45), additional benefits (2.67), and operational procedures (2.82) also reflected low satisfaction ratings. Conversely, the categories that received higher satisfaction scores included supervision (4.66), the nature of the work (4.34), and relationships with colleagues (4.25) [19].

The second questionnaire was designed to evaluate patient satisfaction in ten public hospitals located in Athens, covering the period from June 2019 to December 2021. This research utilized the questionnaire developed by Aletras, Basiouri, Kontodimopoulos, Ioannidou, and Niakas (2009) [20]. A statistical analysis was conducted on a total of 57 items, which primarily included closed-ended questions formatted in a Likert scale. These questions employed a 6-point intensity scale, which ranged from “strongly disagree” to “strongly agree”, with the following numerical values assigned: 1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, 5 = strongly disagree, and 6 = do not know/no answer. The survey encompassed 12 questions (items 2–13) that focused on the processes of waiting, arrival, and admission. Additionally, it contained 9 questions (items 14–22) regarding the behavior of nursing staff, 9 questions (items 23–31) focusing on the behavior of medical personnel, and 5 questions (items 32–37) related to the actions of other hospital staff. Furthermore, the survey included 3 questions (items 38–40) concerning the food services, 10 questions (items 41–50) regarding the internal environment, 4 questions (items 51–54) focused on the organization of hospital procedures, and 3 questions (items 55–57) assessing the overall performance of the hospital. The research involved 3724 patients aged 18 and above who had been admitted to the hospital and agreed to participate, yielding a response rate of 93%. Data gathered after the end of 2020 were excluded from the regression analysis, leading to a total of 2851 participants. Overall, the level of patient satisfaction with the healthcare services provided by these hospitals was moderate, as approximately two-thirds of the participants (67.38%) reported being satisfied with the care that they received. Positive influences on overall satisfaction were noted in interactions with medical and nursing staff (3.75/5) and other personnel (4/5). Nonetheless, dissatisfaction was primarily linked to extended waiting times, accessibility to medical services, delays in scheduled procedures (3.50/5), and issues related to outdated facilities and equipment (3.56/5) [21].

3.2. Statistical Analysis

Descriptive analyses were performed to outline the general characteristics of the sample. The relationships among the variables were represented by beta coefficients (β), along with 95% confidence intervals. A two-tailed p-value of less than 0.05 was set as the criterion for determining statistical significance. Furthermore, ordinary least squares (OLS) and two-stage least squares (2SLS) regression analyses were utilized as statistical techniques to investigate the structural equations. All statistical evaluations were carried out using SPSS version 26.0 (IBM Corp., Armonk, NY, USA).

3.3. Validity and Reliability Analysis

The validity assessments of the questionnaire revealed values between 0.81 and 0.98, with a Cronbach’s α of 0.89 for employee satisfaction [19]. For patient satisfaction, the Cronbach’s coefficients varied from 0.85 to 0.96, while the test–retest reliability coefficients ranged from 0.814 to 0.970. Additionally, the inter-rater reliability correlations were found to be between 0.811 and 0.978 [21].

3.4. Ethical Permission

The research protocol was sanctioned by the Ethical Committee of the National and Kapodistrian University of Athens (protocol number: 1819023327-25/2/2019). Furthermore, the 1st Regional Health Authority of Attica provided its approval (approval number: 31707-7/6/2019), contingent upon obtaining written consent from the appropriate institutional ethics and research committees of each participating hospital, with the condition that the identities of the hospitals would not be disclosed. The study complied with the guidelines established in the Helsinki Declaration of 2013.

4. Empirical Investigation of the Interactions Among Employees and Patients

The questionnaire data for employees and patients were collected in parallel and analyzed in relation to the specific hospital clinics where healthcare professionals operate and patients receive care. This setting serves as the foundation for the interactions between healthcare personnel and patients. We propose that interactions occurred between the patients and the healthcare staff who filled out the questionnaires during that period. The analysis was confined to the timeframe from July 2019 to December 2020, excluding any patient satisfaction assessments conducted after 2020, due to the absence of corresponding measurements of healthcare professionals’ satisfaction during that period [19,21].

4.1. Description of the Sample

In the study of employee satisfaction, a sample of 3278 professionals was analyzed, of which 2666 (81.33%) were female and 612 (18.67%) were male. The participants’ age distribution was as follows: 1.49% were aged under 25 years, 15.86% were aged 26 to 35 years, 33.25% fell within the 36 to 45 years range, 38.16% were aged between 46 and 55 years, and 11.23% were aged over 56 years. Furthermore, the respondents’ tenure varied, with 19.37% having less than 5 years of employment, 11.90% with 6 to 10 years, 17.63% with 11 to 15 years, 22.45% with 16 to 20 years, and 28.65% possessing more than 20 years of experience. The respondents’ roles were classified as follows: 24.50% were physicians, 52.96% were nursing staff, and 22.54% were categorized as other personnel. Regarding employment status, the majority were permanent employees, totaling 2.66 individuals (80.99%), while 623 individuals (19.01%) were temporary personnel. Approximately half of the participants reported being able to meet their financial obligations, albeit with limited savings, while 40% experienced significant financial difficulties. In questions concerning the “nature of work”, a substantial majority of the hospital employees (physicians 4.47, nursing staff 4.32, and other healthcare staff 4.24) indicated a strong sense of job satisfaction, with 78.39% reflecting positive sentiments regarding the intrinsic aspects of their roles. Additionally, 63.03% of the participants reported that they perceived their work as meaningful, while an impressive 92.01% expressed pride in the contributions that they have made to society. Male respondents indicated a marginally higher level of job satisfaction compared to female respondents, on a satisfaction scale ranging from 1 to 6, achieving an average score of 3.49; this score reflects a neutral perspective regarding job satisfaction. The satisfaction score for females was 3.30. Both genders expressed greater satisfaction with “Co-workers” (4.37 for males and 4.23 for females) and “Nature of Work” (4.34 for both). Conversely, satisfaction levels were lower regarding “Pay” (2.42 for males and 2.05 for females) and “Promotion” (2.77 for males and 2.38 for females). Notably, in the area of “Supervision” (physicians 4.73, nursing staff 4.66, other healthcare staff 4.57), female respondents reported slightly higher satisfaction than males, with scores of 4.61 and 4.67, respectively. These findings reveal a weak correlation between gender and the different aspects of job satisfaction. A thorough analysis based on age revealed variations in job satisfaction across different age groups. Although these variations were modest (M = 3.30–3.60), the youngest respondents, aged 25 and under (M = 3.60), expressed higher levels of satisfaction compared to their middle-aged counterparts (26–45 years). In contrast, individuals aged 46 to 55 years (M = 3.30) reported lower levels of satisfaction [19].

The study on patient satisfaction included a total of 2851 participants, comprising 51.14% women and 48.86% men. The age distribution of the respondents was as follows: under 17 years (0.28%), 18 to 30 years (2.67%), 31 to 44 years (9.47%), 45 to 60 years (24.48%), 61 to 74 years (44.55%), and over 75 years (18.55%). A significant majority of the patients were married (73.59%), while 6.87% were single, 5.51% identified as divorced, and 14.03% were widowed. In terms of employment status, 39.21% were employed in the private sector, 37.60% were retired, 6.77% were public sector employees, 7.79% were freelancers, and the remainder fell into other employment categories. A notable 95.51% of the sample held Greek citizenship. Regarding their place of residence, 89.65% of the patients reported living in Attica, while 10.35% resided in the provinces but opted for hospitalization in an Athens facility. Financially, 76.25% of the patients described their situation as very difficult, whereas 21.15% stated that they were managing but faced financial constraints, 1.37% indicated an inability to afford their expenses, and only 0.56% reported having no financial issues, while 0.67% chose not to disclose information regarding their financial situation. The length of hospitalization varied, with 40.76% staying for 2 to 5 days, 54.44% for 6 to 15 days, 3.23% for 16 to 30 days, and 1.58% for more than a month [21].

The average satisfaction levels of the healthcare professionals (3278) were comparable with the average satisfaction levels of inpatients (2851) regarding the services provided, which helps mitigate the issue of endogeneity to a certain degree. We acknowledged the possibility of endogeneity, which primarily arises from the bidirectional dynamics of the physician-patient relationship. Additionally, there is a concern that patients might provide inflated satisfaction ratings, potentially basing their evaluations solely on positive health outcomes rather than the quality of communication with their physician. The analysis ultimately revealed a total of ninety-seven (97) common observations made by both medical personnel and patients within the same hospital clinics throughout the designated research period [22,23,24].

4.2. SLS and OLS Regression Results

Causality has long been a focal point of inquiry across various scientific disciplines. The concept of causality poses challenges in quantification within scientific research, particularly due to the confusion that often arises between causality and correlation. While correlation and causation are interrelated phenomena, establishing a causal relationship requires meeting three essential criteria: correlation, temporality, and the exclusion of alternative explanations. To establish a causal relationship between phenomenon A (the potential cause) and phenomenon B (the observed effect), it is essential that A and B are consistently correlated, that A precedes B in time, and that no alternative factors can explain the variations observed in B. This underscores the notion that while correlation is not equivalent to causation, it is a prerequisite for establishing a causal relationship [23].

A key challenge that may arise in regression analysis is the inconsistency of parameter estimates resulting from endogeneity. A variable is deemed to be endogenous when it is associated with the confounding term, suggesting that the assumption of independence between the explanatory variables and the confounding term has been violated. The main reason for the occurrence of endogeneity is the bias due to the omission of variables that affect the dependent variable. When an independent variable is excluded from the model yet plays a crucial role in interpreting the dependent variable, its influence may be mistakenly attributed to other independent variables present in the model, leading to inaccurate parameter estimates. Additionally, endogeneity may occur due to bidirectional causality, in which the independent variable is found to influence the dependent variable, while at the same time, the dependent variable also exerts an influence on the independent variable. Bidirectional causality leads to misinterpretation of the dependent variable. Finally, an additional reason for endogeneity is measurement errors in the explanatory variables. When it comes to variables for which there are insufficient data, it is possible that an approach is used that does not correctly express the corresponding variable, or that the data may not have been collected or recorded correctly. Numerous approaches are available to address the issue of endogeneity. One method utilized is the fixed-effects model, which includes an auxiliary variable designed to account for distinct characteristics that may be reflected in other explanatory variables within the model, along with unobserved influences. Another commonly employed technique is the two-stage least squares (2SLS) method, which utilizes instrumental variables. Specifically, these instrumental variables are chosen based on their correlation with the independent variable while remaining uncorrelated with the error term, either by design or by assumption, and they must also be exogenous. In the initial stage of this method, each endogenous explanatory variable is regressed against all exogenous variables in the model using ordinary least squares (OLS), yielding estimates for the endogenous variable. In the subsequent stage, the regression analysis proceeds as usual, substituting the endogenous variable with its estimate obtained from the first stage [23,25,26,27,28,29,30]. This reduces the bias of the estimators resulting from the endogeneity problem. Therefore, in a model of the form

$$\mathrm{Y}=\mathrm{X}\mathrm{b}+\mathrm{u}$$

Endogeneity is characterized by the condition E(u|X) ≠ 0, indicating that the presumption of independence between the dependent variable and the confounding variable has been breached. Thus, to solve the endogeneity problem, we need to find auxiliary variables based on some assumptions. First, the exogenous variable should be correlated with the independent variable (Corr(ZX) ≠ 0), and secondly, it should be exogenous, i.e., E(u|Ζ) = 0, because otherwise it would have to be introduced into the regression and function as an explanatory variable for Y, and in this case the assumption of exogeneity would not hold. A commonly employed estimation technique utilizing auxiliary variables is the two-stage least squares method. In the initial stage, we derive the adjusted values $\widehat{\mathrm{X}}$ from the regression of the auxiliary variables on the independent variables X = Zγ + v. In the subsequent stage, we estimate the regression Y = $\widehat{\mathrm{X}}$b + u so as to obtain the consistent effects, provided that the auxiliary variables that we used were the correct ones [23,28,31,32,33,34,35].

In their 2008 study, Clever et al. examined the connection between physicians’ communication practices and patients’ overall satisfaction with their care. They employed an innovative methodology to identify an auxiliary variable that could mitigate the confounding effects of patient characteristics on this relationship. In order to address the complexities of bidirectional causality and various influencing factors, the authors created a novel metric aimed at evaluating physicians’ communication behaviors, specifically designed to be unaffected by patient-related variables that might influence overall satisfaction. This metric was intended to serve as an auxiliary variable in the examination of how communication affects patient satisfaction. To establish this variable, the authors computed the average ratings of physicians’ communication behaviors derived from feedback provided by other patients receiving care from the same physicians [24].

In the specific research undertaken here, our objective was to assess how physician satisfaction influences patient satisfaction. The independent variable representing physicians’ satisfaction in their roles may be regarded as endogenous, as there is a connection between job satisfaction and patient satisfaction; conversely, patient satisfaction can also affect physician satisfaction. That is, patient satisfaction affects healthcare professionals. There is therefore a problem of bidirectional causality between the two variables. For this reason, we will use two variables as auxiliary variables to correct the problem of endogeneity. The first variable is the dummy variable for the clinic in which the patient is located, which is a basic condition for the existence and development of the physician–patient relationship, while the second measure reflects the mean of the responses regarding the likelihood of the patient returning to the particular clinic of the hospital. The choice of this question was made for three main reasons, and particularly because it is consistent with previous literature on the subject, because the question refers to an overall assessment of the patient and is therefore considered to be more objective than individual measurements of hospital characteristics. Finally, what every health system desires, and what this study also investigated, is the patient’s satisfaction with their experience and their statement that they trust the healthcare provider. In

Table 1. Investigation of healthcare personnel–patient interactions; N = 97.

Results of 2SLS and OLS Regressions Predicting Patients’ Satisfaction on Healthcare Personnel Job Satisfaction	TSLS	OLS
c	−0.636	0.324
Healthcare personnel job satisfaction	1.1215 ***	0.7984 ***
R-squared	0.255	0.305
Adjusted R-squared	0.247	0.298
S.E. of regression	0.185	0.178
F-statistic	32.015	41.725
Prob (F-statistic)	0.000	0.000
J-statistic	2.796
Prob (J-statistic)	0.094

Note: *** indicates significance at the 1% level.

, we present the results of the regression of healthcare personnel satisfaction on patient satisfaction.

The first column lists the results of the two-stage regression, with the clinic dummy variable and the variable for whether they would visit the same hospital again as auxiliary variables. Furthermore, we performed three tests to determine the appropriateness of the auxiliary variables. Initially, we conducted the Andrew–Rubin test to assess the overidentification of the constraints, resulting in a probability value of 9%. This suggests that, at the 5% significance threshold, we do not reject the null hypothesis, implying that both auxiliary variables are valid and exogenous. Additionally, a common guideline for assessing the strength of the auxiliary variables in the regression is to conduct an F-test during the first-stage regression of these variables against the dependent variable; the F-statistic should exceed 10 to ensure that the estimates remain unbiased. The F-test value was 33.59, which confirms that the auxiliary variables that we used were strong enough to avoid biasing the results in the two-step regression. Therefore, from the two-step regression, we observed that a possible increase in the professional satisfaction of the medical personnel by 1 unit showed a positive sign in the physician-patient relationship and led to an increase in patient satisfaction by 1.12 units [32,33,34,35].

In conclusion, this research presents positive interactions in the relationships between healthcare personnel, especially physicians, and patients in the hospitals where this research conducted, while no evidence of endogeneity presented from the comparison of the two different questionnaires developed to determine the satisfaction of physicians and patients.

4.3. Studies That Investigated the Interactions Between Healthcare Professionals and Hospitalized Patients

Limited research has been conducted in the past utilizing two distinct questionnaires aimed at healthcare professionals and hospitalized patients, yet these studies have not produced any quantifiable outcomes. Shibu et al. (2013) examined the influence of job satisfaction on patient satisfaction. Their research employed two distinct questionnaires: The first was directed at employees and gathered personal details along with 19 questions, comprising 14 closed-ended and 5 open-ended items. The second questionnaire was given to 158 patients, collecting their personal information and consisting of 12 questions, of which 11 were closed-ended and 1 was open-ended. The results indicated that the employees were dissatisfied with the benefits provided by the organization and felt that they had been exploited beyond reasonable expectations. A significant proportion of the employees reported that this was guided by outdated and ambiguous organizational policies [36]. Concurrently, Janicijevic et al. (2013) explored the relationship between healthcare provider satisfaction and patient satisfaction. Data were collected via survey questionnaires from a total of 18,642 healthcare professionals and 9283 patients across fifty secondary healthcare facilities in Serbia. The analysis utilized descriptive statistics alongside correlation techniques. In the final stage of the study, the relationships between employee satisfaction indicators and patient satisfaction indicators were evaluated. The results demonstrated statistically significant correlations, suggesting a minimal level of association between employee satisfaction and patient satisfaction. Specifically, the correlation analysis identified a modest yet statistically significant link between healthcare professionals’ satisfaction regarding the time allocated for their duties and patients’ satisfaction with the treatment outcomes and overall service quality provided by healthcare professionals [37].

5. Limitations and Future Research

As discussed above, while there is substantial evidence linking physician satisfaction to patient satisfaction, a direct causal relationship with measurable outcomes has not been conclusively demonstrated in the past. Many studies are observational, and confounding factors such as communication, access to healthcare, and positive health outcomes may influence their findings. Also, the independent variable representing physicians’ satisfaction in their roles may be regarded as endogenous, as there is a connection between job satisfaction and patient satisfaction. Conversely, patient satisfaction can also affect physician satisfaction. The above was limited by the use of narrowly defined questions that linked the two questionnaires and analyses through the 2SLS and OLS regressions. More controlled trials and long-term studies are needed to determine whether improving job satisfaction can directly improve patient satisfaction, and to what extent.

Future research should also investigate the connection between job satisfaction and patient satisfaction, at the primary care center as well as healthcare facilities where the potential impacts of treatment (e.g., cancer, heart diseases, etc.) are crucial for society. Understanding these pathways could lead to new strategies for addressing these problems.

6. Discussion

In the last twenty years, numerous reform initiatives have been introduced to enhance the coordination of care across various health sectors. In Greece, a significant reform involved administrative changes that created healthcare regions, which function as independent and decentralized service units, thereby promoting the decentralization of the healthcare system. This redistribution of responsibilities aimed to reduce the burden on the Ministry of Health while empowering regional administrative entities, particularly those managing hospitals, to take more decisive actions. Additionally, reforms in primary healthcare were enacted to alleviate pressure on hospitals. The creation of a family doctor system, functioning within a strong implementation framework, has the capacity to significantly enhance the quality of healthcare services for patients. Moreover, Local Health Units (ΤOΜΥ) are being incorporated into the Greek primary care system to broaden the range of services focused on preventive healthcare. However, the Greek healthcare system faces several challenges, including fragmented healthcare services, inadequate implementation of the family doctor model, incomplete legislation, and various structural obstacles, all of which impede progress in development efforts [38,39,40,41,42].

This research focuses on the dynamics between patients and healthcare providers, rather than the overall hospital experience, revealing that patient engagement and collaborative decision-making are often restricted within the Greek healthcare system. In the context of healthcare, service providers seem to exert more power in the patient–provider relationship than is typical in other service industries. This dynamic arises from the inherent asymmetry of the relationship, where the recipient encounters or perceives significant complexity in the medical services rendered. Restricting communication with patients and their families can lead to a diminished emphasis on person-centered care. This indicates that an excessive prioritization of system efficiency promotes a prevailing market-driven logic, which is unsuitable for delivering care that is centered around the individual.

This study provides a comprehensive framework for analyzing and comprehending the scope and significance of the relationship between patients and healthcare providers, as well as the management of care from the patients’ perspective. The significance of interactions between physicians and patients, along with their potential impact on patients’ behavior and overall well-being, has gained considerable acknowledgment. Essentially, patients appeared to experience satisfaction when (1) their physician is relevant to their illness, has the appropriate technical knowledge and skills, and knows their personal medical history so that they do not have to repeat the same information over and over again; (2) they have the opportunity to have more detailed knowledge regarding their health concerns, specifically about the treatment protocols that they will undergo, potential outcomes, side effects of treatments, and self-care strategies that will be followed; (3) they are informed about the procedures that will follow after their admission (i.e., the waiting time for a surgical procedure or for test results) and these processes are executed without unnecessary delays; (4) both patients and their relatives have the opportunity to communicate with and consult their physician as needed, with the use of clear explanations and instructions (often, primary patient grievances do not stem from the physician’s expertise but, rather, from ineffective communication that leads to misunderstandings and diminished satisfaction with the care provided; numerous studies indicate that the time allocated for hospitalized patients’ communication is not always prioritized within healthcare organizations, and a lack of time can hinder holistic care); (5) they are treated with dignity, courtesy, respect, and empathy by healthcare professionals, treating the patient as an individual and not as a problem (instances of indifference or delayed responses from nursing staff regarding patients’ pain have been reported); and (6) they have the opportunity to take a more active role in managing their own care and treatment, as the world becomes more and more informed and digitalized. Numerous additional studies corroborate our findings, suggesting that these elements are fundamental prerequisites for establishing a trusting relationship between patients and health professionals [21,43,44,45,46,47,48,49,50].

Job satisfaction among healthcare professionals is a critical factor that affects both their productivity and their effectiveness within hospitals. Additionally, the satisfaction of healthcare professionals plays a crucial role in determining their quality and commitment to their responsibilities, as well as impacting healthcare costs. This survey indicated that 57.09% of hospital healthcare professionals reported dissatisfaction with their jobs, whereas 42.91% indicated satisfaction. Among these professionals, nursing staff exhibited the lowest levels of job satisfaction, with a rate of 63.67%. In contrast, physicians were the only group that demonstrated a positive level of job satisfaction, with 56.29% expressing contentment. Specifically, the overall job satisfaction perception among healthcare staff in hospitals was rated as moderate, with a mean score of 3.33, based on a scale ranging from 1 to 6. This score can be broken down as follows: physicians averaged 3.61, nursing staff 3.23, and other healthcare professionals 3.28. Immediate measures to improve the working conditions of hospital staff should include offering higher salaries or tax incentives, refining shift schedules, providing avenues for professional growth, hiring more personnel, and implementing a merit-based evaluation system. Additionally, it is crucial to promote effective communication, education, opportunities for acquiring new skills, interpersonal development, involvement in decision-making, acknowledgment of contributions and advancements, occupational safety regulations, and teamwork among staff. These elements are vital for fostering collaboration within the organization and strengthening the relationship between healthcare providers and patients [2,21,51,52,53,54].

Healthcare organizations are required to consistently enhance their services to deliver superior quality at the most competitive rates. The drive for improved quality and reduced costs within the healthcare industry is shaped by the influence of accreditation bodies, media scrutiny, and comparisons with other institutions. It is imperative to assess and elevate the current standards of healthcare quality. Enhancing quality naturally leads to cost reductions by fostering superior services. Quality is undeniably a fundamental component of healthcare services. Subpar quality in healthcare incurs significant costs, resulting in loss of life, wasted time, diminished public trust, low staff morale, and the inefficient use of scarce resources. Healthcare organizations are required to implement processes that are not only efficient and effective but also focused on the needs of patients and their families. These processes should be informed by the most recent operational management models and research insights. The emotional quality of consultations appears to be the key factor in achieving improved outcomes. A vital component of this is the enhancement of communication between patients and physicians, which is essential for fostering a strong relationship. The implementation of a “relational model” emphasizes the importance of the quality of interactions between patients and physicians. This approach shifts the physician’s role from merely being an expert who imparts knowledge to a more collaborative relationship where both parties actively engage in the exchange of information. Consequently, patients evolve from being passive recipients of information to becoming active and essential participants in their own healing journey. Already, numerous physicians advocate for shared decision-making, encouraging patients to engage actively in their healthcare and to gain a clearer understanding of the risks linked to different treatments and medications. This highlights the importance of a strong collaborative relationship between healthcare providers and patients, as trust is a fundamental element in their interactions. This aspect is particularly significant in the realm of healthcare services. Clearly, fostering effective communication and relationships between patients and healthcare professionals can improve the efficiency of healthcare delivery, the quality of medical services, and the recovery outcomes for patients [55,56,57,58,59]. More than ever, the process of digitalizing healthcare extends beyond merely acquiring computers or investing in software. True digital transformation in the health sector requires the modernization of healthcare facilities, innovative thinking, and the development of new healthcare delivery models, as well as the seamless integration of data and care across the entire patient journey. Consequently, it is essential to enhance the technological sophistication across all components of the healthcare value chain. This endeavor will certainly yield a return on investment, necessitating a fundamental shift in mindset among professionals, organizations, and the funding frameworks that support them [60,61,62,63,64].

7. Conclusions

Instrumental variable estimations, including two-stage least squares (2SLS) regression, provide a reliable and efficient method for acquiring consistent estimates regarding the impact of an endogenous regressor on its dependent variable. A pilot study was conducted involving two distinct cross-sectional surveys, focused on job satisfaction among Greek healthcare providers and patient satisfaction within secondary care organizations, encompassing ten hospitals in Athens. The surveys included all employees present at work from July 2019 to December 2020.

Patient satisfaction stands out as the most acknowledged and frequently utilized outcome measure. This prominence likely stems from its inherent “logical and intuitive appeal”. Consequently, this study explored the connection between the satisfaction levels of healthcare professionals and those of patients. The results of our survey revealed that 63.03% of participants reported that they perceived their work as meaningful, and an impressive 92.01% expressed pride in their contributions to society, although the average score for the overall perception of job satisfaction among healthcare personnel in the 1st Healthcare Region of Attica averaged 3.33 on a scale of 1 to 6, with physicians scoring 3.61, nursing personnel 3.23, and other healthcare professionals 3.28, reflecting a sense of ambivalence. Accordingly, the degree of patient satisfaction regarding the healthcare services offered by these hospitals was found to be moderate, with around two-thirds of the respondents (67.38%) indicating that they were satisfied with the care that they received. Significant positive influences on overall satisfaction were observed in interactions with both medical and nursing personnel (3.75/5) and other staff (4/5), with the other factors detracting. Notably, physicians rated the “nature of work” at 4.47, suggesting a strong dedication to their professional responsibilities despite the financial challenges and deficiencies present in the Greek health system. Furthermore, it was demonstrated that an increase of 1 unit in the professional satisfaction of medical personnel showed a positive sign in the physician–patient relationship and was correlated with a 1.12-unit rise in patient satisfaction. The data at our disposal suggest that additional investigation into this research domain would be beneficial to ensure public health.

As the landscape of healthcare services has undergone significant evolution and has become more complex worldwide, physicians have the opportunity to assume a more proactive and essential role by reimagining their engagement with patients. This involves practicing active listening, treating individuals with respect, and cultivating a collaborative partnership aimed at improving health outcomes. These approaches challenge the traditional roles of patients and physicians, suggesting that interventions aimed at transforming the patient–physician relationship could significantly enhance the quality of healthcare. Additionally, this study highlights the necessity of improved communication practices that balance the power dynamics between healthcare professionals and patients. Such practices should be integrated into educational curricula to promote a more equitable and less paternalistic healthcare approach. Moreover, organizational frameworks and decision-makers must allocate resources to prioritize dialogue in everyday interactions, thereby improving the overall quality of healthcare delivery.