Patient-centered care is essential for delivering high-quality healthcare, focusing on understanding patients’ perspectives to ensure safe and effective services [1–3]. Healthcare organizations are increasingly adopting patient-centric models, recognizing that patient satisfaction directly influences treatment adherence, reduces preventable errors, lowers staff turnover, decreases hospital readmissions, and enhances overall patient engagement and health outcomes. The World Health Organization emphasizes the strong link between patient satisfaction and improved treatment adherence and health outcomes [4, 5]. However, some studies indicate that an excessive focus on patient satisfaction might compromise clinical quality by prioritizing patient preferences over evidence-based practices [6]. This conflicting evidence demonstrates the need for further research, especially in outpatient primary care where data is limited and inconsistent.

A national study of U.S. acute care hospitals found that those with high adherence to clinical guidelines also achieved better patient experience scores [7]. Interestingly, hospitals with the lowest risk-adjusted mortality rates for acute myocardial infarction had the highest patient experience scores [8]. These findings suggest that prioritizing patient experience does not necessarily undermine clinical quality. Further studies support this, showing that hospitals excelling in patient experience also report lower mortality and readmission rates and better adherence to surgical process measures [7, 9, 10]. This trend is consistent across various settings, including ambulatory care [9, 11–13].

In Canada, focusing on patient experiences and patient-centered care is critical given the country’s health system performance challenges compared to other high-income nations. A 2019 Commonwealth Fund study ranked Canada last among 11 high-income countries for timeliness and efficiency of care [14]. A tragic illustration of these systemic delays comes from a recent case where a patient in Montreal, after waiting six hours for care and ultimately leaving the emergency department, died of an aneurysm [15]. With only 127 family physicians or nurse practitioners per 100,000 Canadians as of 2023 [16], the shortage of primary healthcare providers leads to increased hospital visits during health crises and chronic condition management, potentially overwhelming the system [17]. Accessibility is further limited, with only 41% of Canadians able to see a healthcare provider the same or on next day when needed [18], and even lower rates among economically disadvantaged populations [19], pointing to the need for equitable healthcare access. These accessibility issues significantly impact patient outcomes and experiences. In the 2021-2022 fiscal year, 14.6% of mental health patients in Ontario had at least three hospital stays within a year, up from around 0.2% in 2017 [20]. This rate is 19% higher in economically disadvantaged neighborhoods, highlighting the disproportionate effects on vulnerable groups, including those with mental health conditions and lower socioeconomic status.

The COVID-19 pandemic exposed and intensified weaknesses in Canada’s healthcare system, such as provider shortages, accessibility issues, and disparities in patient outcomes [21]. Hospital overcrowding, staff shortages, and supply chain disruptions strained resources, with COVID-19 cases and deaths peaking in January 2022 [22] and totaling over 4.9 million cases and 59,000 deaths by May 2024 [23]. The pandemic showed the need for resilient healthcare systems and emphasized patient-centered care, especially for those with chronic conditions or compromised immune systems [24, 25]. Recent reports indicate there has been ‘no respite’ for Ontario patients facing long wait times and understaffed facilities, emphasizing the chronic strain on the provincial healthcare system [26]. Moreover, the mass departure of nursing professionals during the pandemic exacerbated healthcare access issues [27–29].

Research has effectively used natural language processing (NLP) and machine learning (ML) to analyze patient reviews, automating tasks such as topic classification and sentiment analysis [30–39]. However, most studies focus on online reviews on social media platforms or patient forums, lacking comprehensive analyses that incorporate equity, diversity, and inclusion (EDI) perspectives for diverse socioeconomic and demographic groups.

This study applies NLP to more than 120,000 de-identified patient reviews from 45 Ontario hospitals (2015–2022), seeking to identify factors that drive patient satisfaction, assess performance trends across units, and pinpoint care disparities for low-income and minority populations. To our knowledge, this is the first time this dataset has been analyzed using NLP and ML, providing fresh insights into patient satisfaction and equity [40]. Over 80% of hospitals had less than 50% positive reviews, revealing a decrease in positive feedback over seven years. We also found notable differences in satisfaction across regions, especially in areas with higher percentages of visible minorities and low-income communities, calling attention to the need to address inequities and establish a fair healthcare landscape.

The dataset spans January 2020 to December 2022, capturing pandemic conditions and offering a window into how public health emergencies influence patient satisfaction. Pinpointing what contributed to positive experiences during COVID-19 can help design stronger healthcare systems for future crises, ultimately promoting more responsive, inclusive, and patient-focused care in Ontario and elsewhere.