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Background Patient experience data can support hospital quality improvement initiatives. Unsolicited online hospital reviews have emerged as an alternative data source in addition to traditional survey methods. However, the content and actionability of qualitative online reviews for Canadian hospitals are unknown.Methods We conducted a nationwide cross-sectional study analysing Google Review text comments of Canadian acute care hospitals from 2017 to 2022. We analysed a random sample of 1000 comments from June 2017 to June 2022. We characterised the polarity, actionability and thematic content of these comments.Results Patients were more likely to leave negative reviews (47.9%) than mixed (19.8%) or positive (32.3%) reviews. Most reviews (74.0%) were semiactionable or very actionable. Negative or mixed reviews were generally more actionable than positive reviews (p<0.001). Lastly, patients were most likely to comment on interpersonal interactions with staff and wait times for care.Conclusions Qualitative online patient reviews contain actionable feedback. This can provide a source of real-time data to monitor and improve on patient experience.