To stand out in the hot spring tourism industry, customer satisfaction has become the crucial issue for competitiveness. A company cannot implement several customer satisfaction improvement practices altogether with limited resources. Researchers advocate that companies should evaluate the relationships among success factors and explore determinants for their improvement implementation. However, such a relationship evaluation has not yet been adequately performed. This paper intends to explore the determinants for improving hot spring customer satisfaction. Adopting grounded theory (GT) and using data collected from websites, Ctrip and Qunar, the first 12 key factors for customer satisfaction were identified. Then, their interrelationships were assessed by 15 experts, and interpretive structural modeling (ISM) was employed to analyze the interrelationships and the driving and dependence power among key factors. The results show that "Environment Quality", "Special Resource", "Convenience", "Food", Service Quality", and "Facilities" were the decisive factors affecting customer satisfaction. The findings offer important implications for hot spring management and practice. The contribution of this study is using a novel approach to establish a hierarchical structural model for comprehensive understanding of factor relationships that influence hot spring tourists' satisfaction and to explore decisive factors which can help hot spring practitioners to better plan and design effective improvement strategies to attract potential new consumers and retain their current consumers, especially with limited resources.2 of 20 management, and the rating of "hot springs towns" [4]. However, the market of hot spring resorts is gradually becoming more saturated with more intense competition. Consequently, it becomes difficult for the management to distinguish their operations from other market participants in order to increase or maintain their market share if they do not strategically change or improve.Applicable to both tourism and leisure activities, hot spring resources are not only viewed as a large steaming pool and a "health spa"; instead, they have become cultural carriers for fitness, relaxation, and leisure tourism [5]. Compared with those of sightseeing tours, consumers of hot spring tourism demand higher satisfaction. Delivering superior customer value and satisfaction is crucial to a destination's competitive edge [6]. In the largest contemporary service industry, one of the greatest challenges encountered by management is to deliver and maintain customer satisfaction [7,8]. Contemporary tourists want to have a unique experience and are no longer interested in purchasing a standardized product/service; therefore, to meet the new demands, tourist destinations must assign top priority to achieving tourist satisfaction [9]. On the other hand, with the development of the Internet and social networks, it is easier to transfer customers, and it is more difficult to maintain customer loyalty. Keeping high customer satisfacti...