To assess patient satisfaction following outpatient endoscopic procedures at Naimat Begum Hamdard University Hospital and to identify the major contributors to dissatisfaction using Pareto analysis to guide quality improvement strategies.

This prospective observational study enrolled 300 consecutive outpatients undergoing endoscopic procedures from the Gastroenterology Department. After undergoing the procedure, all patients filled a structured satisfaction questionnaire assessing the following domains: (1) pre-endoscopy guidance and booking communication, (2) interaction with staff on the day of the procedure, (3) waiting time, (4) technical aspects of the procedure, (5) discomfort during endoscopy, (6) sedation-related concerns, and (7) post-procedure recovery. Procedures included 210 upper gastrointestinal (GI) endoscopies and 90 colonoscopies. The study population consisted of 180 males and 120 females. All participants completed the satisfaction form.

Dissatisfaction responses were categorized and quantified. A Pareto analysis was applied to identify the most frequent contributors to dissatisfaction and to determine the “vital few” domains responsible for the majority of negative feedback. Descriptive statistics were used to calculate proportions and cumulative percentages.

A total of 62 dissatisfaction events were reported across all domains. Pre-endoscopy communication issues were the leading source of dissatisfaction, reported by 22 patients (35.5%), primarily relating to booking confirmation delays or inadequate instructions. Sedation-related anxiety was the second most common issue, reported by 14 patients (22.6%), predominantly among younger female patients. Endoscopy-related discomfort was noted in 12 patients (19.4%); discomfort was higher among colonoscopy patients (n = 8) compared with upper GI endoscopy (n = 4). Other issues contributed smaller proportions, including waiting time (6 patients, 9.7%), staff interaction concerns (4 patients, 6.5%), technical/information-related issues (2 patients, 3.2%), and delayed recovery discharge (2 patients, 3.2%).

Pareto analysis showed that the top three dissatisfaction categories—communication issues, sedation-related anxiety, and procedural discomfort—accounted for 77.4% of all dissatisfaction events. This aligns with the 80/20 principle, indicating that addressing these three domains would yield the greatest improvement in overall patient satisfaction. The remaining categories collectively contributed only 22.6% of dissatisfaction, indicating relatively minor impact.

Communication gaps, sedation-related anxiety, and procedural discomfort were the main contributors to dissatisfaction, accounting for most negative feedback. Focusing on improving pre-procedure counselling, appointment communication, and patient reassurance may significantly enhance overall satisfaction.