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Physician review websites (PRW) and Medicare requirements are pressing administrators to measure, monitor and improve healthcare service delivery. Healthcare service attributes linked to patient satisfaction have received increased attention. Text analysis provides an alternative methodology to capture contemporaneous data on service delivery attributes. A Kano analysis based on these service attributes can help administrators prioritize service delivery and ultimately improve patient satisfaction.

Healthcare service attributes were defined from 4,000+ comments on a PRW using latent content text analysis. The resulting 15 attributes were validated by medical professionals using a q-sort methodology and analyzed using a Kano methodology.

The 15 attributes cover three domains of healthcare service – clinic operations, competency and care. The Kano analysis yields a hierarchy, or pyramid, of healthcare service attributes: (1) must-be’s: establish service operational capabilities and benchmark peer performance; (2) satisfiers: establish and increase trust through: (a) clinical competence, (b) careful management of young patients and (c) delivery of appropriate care and treatment (3) delighters: use service-dominant logic to provide patient-centered care.

This research bridges the gap between the “what” and “how” that is frequently missing in text analysis of online reviews. We provide a methodology coupled with a Kano analysis, a widely used quality improvement tool, which results in a hierarchy of service attributes that can guide administrators and researchers.