Article Title

Do Clocks Move at Different Speeds? Cultural Variation in the Satisfaction of Wait Time in Outpatient Clinics

Publication Date



wait time, patient-centered care


Background/Aims: Asians report low levels of satisfaction regarding wait time. Expectations about wait time based on cultural norms may contribute to this low satisfaction. We examined drivers of racial/ethnic differences in satisfaction in wait time by comparing subjective satisfaction scores to patient-reported and objective electronic health record (EHR)-recorded wait times.

Methods: We paired patient satisfaction survey data with EHR-recorded actual wait times, visit characteristics and patient demographics. The study population is comprised of patients of a large multispecialty ambulatory care organization in Northern California from 2011 to 2013. Patient satisfaction surveys were mailed to patients after randomly selected clinic visits. We focused on responses from non-Hispanic white (NHW), Asian and Latino patients (n=213,375; 80.6% of 264,781 total responses). Individual survey responses were linked to visit information including wait time in the EHR. Patient demographics (age, sex, English proficiency), visit characteristics (scheduled appointment time, appointment length, time of a day, whether own PCP visit, number of years with the PCP, number of days between visit and survey return), and physician fixed effects were controlled in the multivariate analyses.

Results: After controlling for demographic and visit characteristics, all Asian subgroups reported substantially lower levels of satisfaction with wait time and longer perceived wait time compared to NHW. This trend persisted after further adjusting for EHR-recorded actual wait time. More Chinese and Asian Indian patients (the majority of Asian patients) arrived to the clinic closer to or slightly later than their scheduled appointment time compared to NHW, but their total wait time at the waiting room was shorter. Japanese and Filipinos, on the other hand, arrived sooner and waited longer than NHW. No noticeable difference was observed in wait time measures between Latino and NHW patients.

Discussion: Wait time in clinic is an objective measure that is assessed subjectively in patient satisfaction surveys. The persistent lower satisfaction and longer perceived wait time among Asians suggests that Asians have different expectations regarding wait times. Different cultural norms regarding wait time among Asians should be taken into account to provide culturally competent patient-centered services to a diverse population.




April 1st, 2015


April 28th, 2015