A Systematic Review of the Kano Model's Utility in Classifying Healthcare Service Attributes and Driving Patient Satisfaction
DOI:
https://doi.org/10.30829/contagion.v8i1.26442Abstract
Patient satisfaction is a key indicator of hospital service quality, closely linked to patient loyalty, clinical outcomes, and the reputation of health institutions. However, identifying specific attributes that determine patient satisfaction and dissatisfaction remains a challenge amid the ever-evolving dynamics of healthcare services. The Kano Model offers a useful framework by categorizing service attributes according to their impact on patient satisfaction. This study presents a systematic literature review of the model’s application in hospitals, conducted using the PRISMA protocol. Searches across PubMed, Scopus, and ProQuest for publications from 2019 to 2024 yielded 17 eligible international journal articles, which were analyzed narratively to identify patterns, methods, and findings. Results consistently revealed a hierarchy of patient needs: clinical competence, safety, and accurate information emerged as Must-be attributes, whose absence leads to strong dissatisfaction. Communication quality, responsiveness, and service efficiency were typically One-dimensional attributes, with satisfaction rising proportionally to performance. Digital innovations such as telehealth and personalized services often appeared as Attractive attributes, delighting patients when present but not causing dissatisfaction when absent. . Attribute classification proved dynamic, shaped by clinical context and patient demographics. Furthermore, integrating the Kano Model with frameworks such as SERVQUAL and the Balanced Scorecard enhances strategic prioritization. Several studies also demonstrated that Kano-based interventions can improve both clinical and psychological patient outcomes. Keywords: Patient Satisfaction, Hospital, Kano Model, Service Quality.References
Ali, J., Jusoh, A., Idris, N., & Nor, K. M. (2024). Healthcare service quality and patient satisfaction: a conceptual framework. International Journal of Quality & Reliability Management, 41(2), 608–627. https://doi.org/10.1108/IJQRM-04-2022-0136.
Barrios-Ipenza, F., Calvo-Mora, A., Criado-García, F., & Curioso, W. H. (2021). Quality Evaluation of Health Services Using the Kano Model in Two Hospitals in Peru. International Journal of Environmental Research and Public Health, 18(11). https://doi.org/10.3390/ijerph18116159.
Çakmak, C., & Uğurluoğlu, Ö. (2024). The Effects of Patient-Centered Communication on Patient Engagement, Health-Related Quality of Life, Service Quality Perception and Patient Satisfaction in Patients with Cancer: A Cross-Sectional Study in Türkiye. Cancer Control, 31. https://doi.org/10.1177/10732748241236327.
Cao, M., Peng, Y., Zhou, Y., Zhang, Y., Han, M., & Xie, L. (2025). Optimizing nursing services for orthopaedic trauma patients using SERVQUAL and Kano models. Scientific Reports, 15(1), 1–11. https://doi.org/10.1038/s41598-025-97495-1.
Chen, M. C., Hsu, C. L., & Lee, L. H. (2019). Service quality and customer satisfaction in pharmaceutical logistics: An analysis based on Kano model and importance-satisfaction model. International Journal of Environmental Research and Public Health, 16(21), 1–23. https://doi.org/10.3390/ijerph16214091.
Chen, Z., Yin, A., & Wang, Y. (2024). Demand analysis of General Practice Patients for Teaching Clinic Based on Kano Model. Frontiers in Public Health, 12, 1–7. https://doi.org/10.3389/fpubh.2024.1336683.
de Vasconcelos, C. R., de Carvalho, R. S. M. C., de Melo, F. J. C., & de Medeiros, D. D. (2023). Improving Quality in Public Health Service: An Integrated Approach to the Kano Model and the Balanced Scorecard. Journal of Nonprofit and Public Sector Marketing, 35(2), 215–241. https://doi.org/10.1080/10495142.2022.2066598.
Deng, L., Romainoor, N. H., & Zhang, B. (2023). Evaluation of the Usage Requirements of Hospital Signage Systems Based on the Kano Model. Sustainability (Switzerland), 15(6), 1–18. https://doi.org/10.3390/su15064972
Ding, L., Ding, Y., Wang, Y., Li, X., & Liu, Y. (2025). Analyzing Maternal Needs for “Internet+ Nursing Service” After Hospital Discharge: A SERVQUAL-KANO Model Approach. Journal of Multidisciplinary Healthcare, 18, 721–734. https://doi.org/10.2147/JMDH.S505926
Ferreira, D. C., Vieira, I., Pedro, M. I., Caldas, P., & Varela, M. (2023). Patient Satisfaction with Healthcare Services and the Techniques Used for its Assessment: A Systematic Literature Review and a Bibliometric Analysis. Healthcare, 11(5), 639. https://doi.org/10.3390/healthcare11050639.
Friedel, A. L., Siegel, S., Kirstein, C. F., Gerigk, M., Bingel, U., Diehl, A., Steidle, O., Haupeltshofer, S., Andermahr, B., Chmielewski, W., & Kreitschmann-Andermahr, I. (2023). Measuring Patient Experience and Patient Satisfaction—How Are We Doing It and Why Does It Matter? A Comparison of European and U.S. American Approaches. Healthcare, 11(6), 797. https://doi.org/10.3390/healthcare11060797.
Furtado, R., MacDermid, J. C., Ziebart, C., Bryant, D., & Faber, K. J. (2025). Bridging the Gap: Understanding Patient and Clinician Preferences When Designing Preoperative Education Programs. Journal of Evaluation in Clinical Practice, 31(1). https://doi.org/10.1111/jep.14259.
Kintzle, S., Rivas, W. A., & Castro, C. A. (2022). Satisfaction of the Use of Telehealth and Access to Care for Veterans During the COVID-19 Pandemic. Telemedicine and E-Health, 28(5), 706–711. https://doi.org/10.1089/tmj.2021.0262.
Mehrabian, F., Gilani, M. H. N. doust, & Almaee, A. (2021). Patient Satisfaction With the Quality of Health Services Provided by Public Hospitals in Rasht, Iran. Journal of Holistic Nursing and Midwifery, 31(1), 17–25. https://doi.org/10.32598/jhnm.31.1.2022.
Nuryuliana. (2025). Penggunaan Telemedicine terhadap Peningkatan Kepuasan Pasien dalam Layanan Kesehatan di Indonesia : Systematic Review. OBAT: Jurnal Riset Ilmu Farmasi Dan Kesehatan, 3(4), 167–177. https://doi.org/10.61132/obat.v3i4.1539.
Park, H. N., Park, D. J., Han, S. Y., Tae, J. Y., Jung, K., Bae, E. J., & Yoon, J. Y. (2022). Effect of inpatient experiences on patient satisfaction and the willingness to recommend a hospital: The mediating role of patient satisfaction: A cross‐sectional study. Health Science Reports, 5(6). https://doi.org/10.1002/hsr2.925.
Priya, K. S. (2025). Analyzing the Influence of Patient Safety Culture on Patient Satisfaction Using the Kano Model in a Multispecialty Hospital. Journal of Information Systems Engineering and Management, 10(31s), 2468–4376. https://www.jisem-journal.com/.
Rahim, A. I. A., Ibrahim, M. I., Musa, K. I., Chua, S.-L., & Yaacob, N. M. (2021). Patient Satisfaction and Hospital Quality of Care Evaluation in Malaysia Using SERVQUAL and Facebook. Healthcare, 9(10), 1369. https://doi.org/10.3390/healthcare9101369.
Tang, H., Zhang, W., Jing, M., Zhou, S., & Xu, J. (2025). A study of family care needs after pediatric congenital heart disease interventions based on the KANO model. BMC Cardiovascular Disorders, 25(1), 1–8. https://doi.org/10.1186/s12872-025-05198-2.
Tang, Y., Deng, X., Chen, C., You, L., Gong, J., Liu, X., & Zhou, J. (2025). Analysis of health information needs of elderly patients with chronic diseases based on Kano Model: a descriptive cross-sectional study. BMC Geriatrics, 25(1). https://doi.org/10.1186/s12877-025-06106-1.
Tarigan, U., Ginting, R., & Siregar, I. (2019). The Use of Kano Model to Find the Satisfaction Assessment on the Attributes of an Infant Incubator Product: A Case Study of APrivate Hospital. IOP Conference Series: Materials Science and Engineering, 505(1), 1–6. https://doi.org/10.1088/1757-899X/505/1/012087.
Tripathi, S., Khan, I., Read, C., & Mischler, M. (2021). Capturing the patient’s voice: Kano Analysis of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In Journal of Education and Health Promotion (Vol. 10, Issue 1). Wolters Kluwer Medknow Publications. https://doi.org/10.4103/jehp.jehp_1322_20.
Wang, X., Pei, C., Jia, C., Liu, L., & Liang, H. (2025). Analysis of the service needs of outpatients undergoing thyroid fine needle aspiration biopsy based on the Kano model. BMC Nursing, 24(1), 1–9. https://doi.org/10.1186/s12912-024-02674-6.
Wang, Z., Tang, X., Li, L., Zhou, H., Zhu, Y., Chen, L., Su, T., Liu, M., Pang, X., Yi, X., Liu, L., Liu, J., & Liu, M. (2024). Spiritual care needs and their attributes among Chinese inpatients with advanced breast cancer based on the Kano model: a descriptive cross-sectional study. BMC Palliative Care, 23(1), 1–12. https://doi.org/10.1186/s12904-024-01377-8.
Zhang, M., Zhang, L., Zhi, X., Cheng, F., Yao, Y., Deng, R., Liu, C., & Wang, Y. (2024). Demand analysis of health care services for community-dwelling breast cancer survivors based on the Kano model: A cross-sectional study. International Journal of Nursing Sciences, 11(2), 171–178. https://doi.org/10.1016/j.ijnss.2024.03.015.
Zhu, Z., Chen, L., & Li, K. (2023). Effect of nursing interventions based on the Kano model on symptom relief and parental psychological behavior in children with febrile seizures. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.1067727.
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