Because of size, organizational complexity, departmental autonomy, and tensions among teaching, research, and the daily work of healing, academic medical centers face significant challenges in establishing a culture of patient satisfaction. At the same time, some of these characteristics may aid academic medical centers in efforts to initiate and sustain programs focused on enhancing the patient's experience of care. If successful in these efforts, academic medical centers could be the ultimate legitimizers of patient satisfaction as a key element of quality clinical care.