Purpose – This paper aims to examine the major factors affecting cumulative summation, to empirically examine the major factors affecting satisfaction and to address the question whether patients in Kazakhstan evaluate healthcare similarly or differently from patients in Egypt and Jordan.

Design/methodology/approach – A questionnaire, adapted from previous research, was distributed to Kazakhstan inpatients. The questionnaire contained 39 attributes about five newly-developed quality dimensions (5Qs), which were identified to be the most relevant attributes for hospitals. The questionnaire was translated into Russian to increase the response rate and improve data quality. Almost 200 usable questionnaires were returned. Frequency distribution, factor analysis and reliability checks were used to analyze the data.

Findings – The three biggest concerns for Kazakhstan patients are: infrastructure; atmosphere; and interaction. Hospital staff's concern for patients' needs, parking facilities for visitors, waiting time and food temperature were all common specific attributes, which were perceived as concerns. These were shortcomings in all three countries. Improving health service quality by applying total relationship management and the 5Qs model together with a customer-orientation strategy is recommended.

Practical implications – Results can be used by hospital staff to reengineer and redesign creatively their quality management processes and help move towards more effective healthcare quality strategies.

Social implications – Patients in three countries have similar concerns and quality perceptions.

Originality/value – The paper describes a new instrument and method. The study assures relevance, validity and reliability, while being explicitly change-oriented. The authors argue that patient satisfaction is a cumulative construct, summing satisfaction as five different qualities (5Qs): object; processes; infrastructure; interaction and atmosphere.