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<strong>Introduction:</strong> After long discussions, carrying out health sector evolution (HSE) plan began on May 5, 2014 throughout Iran. Shohadaye Tajrish Hospital, Tehran, was also included in this plan. This study aimed to evaluate the level of emergency department patient satisfaction, before and after running this plan. <strong>Methods:</strong> This cross-sectional study analyzed the data extracted from a standard questionnaire filled out by the patients presented to the emergency department of Shohadaye Tajrish Hospital over 6-month periods before and after the beginning of HSE. <strong>Results:</strong> 3665 patients were surveyed. After the execution of the plan, satisfaction decreased significantly regarding pre-discharge training (p = 0.03), hospitalization room condition (p = 0.0002), restroom sanitation (p = 0.007), waiting time to be visited by the physician (p = 0.04), accuracy and duration of physical examination (p = 0.007), feeling confident and desirable outcome (p = 0.03), commitment to religious and moral principles (p = 0.01), and handling financial affairs (p = 0.03). <strong>Conclusion</strong>: Based on the results of the present study, after execution of HSE plan, patient satisfaction has decreased significantly regarding pre-discharge training, hospitalization room condition, restroom sanitation, timely visit of the physicians, accuracy and duration of physical examination, suggestions for wellbeing of the patient, handling financial affairs, and commitment to religious and moral principles.