New South Wales hospitals are less organised, their staff aren't working together as effectively and the care being provided is not as good, according to the state's patients.
A Bureau of Health Information survey, released on Wednesday, asked more than 19,000 adult patients to rate the care they received throughout 2021.
The results show worse outcomes than the 2020 survey, when patients were asked to rate the hospital they were treated at and the care they received.
BHI chief executive Diane Watson says the COVID-19 pandemic, which pushed NSW into lockdown for months in 2021, appears to have had an impact.
"COVID-19 restrictions may have affected experiences of care, particularly in the second half of the year with the peak of the Delta outbreak and the beginning of the Omicron wave," Dr Watson said.
Some 68 per cent of patients rated the care they received as "very good", down from 71 per cent in 2020.
There were also slight falls when patients were asked to rate how well the health professionals providing care worked together, and how well organised their treatment was.
Patients also felt less involved in their care than they did the previous year.
There were about 3000 fewer respondents across 12 fewer hospitals in 2020.
Nurses fared slightly better than doctors in 2021, with 78 per cent of patients rating them "very good", compared with 74 per cent for doctors.
More than one in five patients reported receiving contradictory information about their condition or how it would be treated.
Rural and regional residents appear to be more satisfied with the care they received.
Across 36 measures there was no significant difference between the two, the BHI reported.
However, rural respondents were significantly more positive across 13 measures, compared with just two for metropolitan patients.
There were about 1400 fewer respondents from metropolitan hospitals than rural or regional ones.
The Hunter-New England health district's Maitland Hospital makes a frequent appearance among those that received "significantly lower" results relative to other hospitals in the state.
However, the results are from 2021. A new hospital opened in Maitland early this year.