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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 24
| Issue : 1 | Page : 89-93 |
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Exploring attributes influencing patient satisfaction in a group of hospitals
Ilankumaran Mookkiah1, MV Singh1, Saurbh Bobdey1, Shankar Narayan2, N Anand3, Kiran Kumar Maramraj1
1 Department of Medical, O/o DGMS (Navy), IHQ MoD (Navy), New Delhi, India
2 INHS Kalyani, Visakhapatnam, Andhra Pradesh, India
3 Department of Medical, Station Health Organisation, Kochi, Kerala, India
| Date of Submission | 25-Oct-2020 |
| Date of Decision | 25-Nov-2020 |
| Date of Acceptance | 29-Nov-2020 |
| Date of Web Publication | 26-Mar-2022 |
Correspondence Address:
Surg Capt (Dr) Ilankumaran Mookkiah
Room No 138, “A” Wing, Sena Bhawan, Integrated Headquarters, Ministry of Defence (Navy), Rajaji Marg, New Delhi - 110 011
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmms.jmms_158_20
Introduction: The main purpose of hospitals is to provide quality care to their clientele. Many studies have been conducted to assess patient satisfaction and suggest measures to improve patient satisfaction in government and private hospitals. This study was conducted in a different setting with the aim to assess patient satisfaction in a group of hospitals exclusively for their entitled clientele. Materials and Methods: The study was a questionnaire-based observational study conducted in nine hospitals belonging to one central administration. The questions pertained to five domains. The data were collected on a numerical scale and the weighted average was calculated for each question. Results: A total of 2850 patients were administered with questionnaire. About 95% of patients were satisfied with services provided by the hospitals. The strengths of the hospitals were the general cleanliness and the way the medical and paramedical staff treat their patients. The weaknesses were the waiting period at reception and to see the doctor as well as the quality of food provided to the inpatients. Conclusion: This study has brought out that a large percentage of patients were satisfied with the services provided by the hospitals. The analysis has facilitated the administrator to know the strengths of the hospitals as well as to identify the weaknesses. It is essential that the administration of the hospitals addresses the weaknesses to further improve the patient satisfaction. In conclusion, it is recommended that patient satisfaction surveys should be part of the Standard Operating Procedure of all health-care facilities and the same should be an ongoing process rather than a one-time measure.
Keywords: Hospitals, infrastructure, medical care, patient satisfaction, personal care, waiting period
How to cite this article:
Mookkiah I, Singh M V, Bobdey S, Narayan S, Anand N, Maramraj KK. Exploring attributes influencing patient satisfaction in a group of hospitals. J Mar Med Soc 2022;24:89-93 |
| Introduction | |  |
The main purpose of hospitals is to provide quality medical care to their clientele with the utmost possible satisfaction. Patient satisfaction can be defined as the fulfillment or meeting of expectations of a person from a service or product.[1] The primary expectation of patients when they visit a hospital is to get cured at the earliest. However, they bring certain minimum expectations to the hospital, which include clean environment, less waiting period, efficient medical and para-medical staff, co-operative reception staff, good amenities, etc.
There are many studies conducted in India to assess patient satisfaction. Some of the studies, conducted in government health-care facilities, have suggested to strengthen infrastructure and human resources; to improve cleanliness of wards and quality of food; to provide clean toilets as well as basic amenities; and to improve communication between patient and doctor, in order to improve patient satisfaction.[2],[3],[4],[5]
Private hospitals, being run on commercial purposes, tend to stride forward to improve patient satisfaction. In a tertiary care hospital in Mumbai, about 91% of individuals reported that their experience was good.[6] Many government health-care facilities also provide impeccable services. One such example is government health-care facilities in Chandigarh with 87.8% of patients satisfied with the outpatient department (OPD) services.[7]
Studies have been carried out to assess patient satisfaction and suggest measures to improve patient satisfaction in government and private hospitals. The present study was conducted in a group of hospitals governed and controlled by the same central administration. The specific objectives were to identify attributes which are valued or unpopular with and accordingly suggest measures to improve patient satisfaction.
| Materials and Methods | | |
The study was a cross-sectional study conducted simultaneously at nine hospitals, controlled by the same central administration, spread across the country. Out of these, one was a tertiary care hospital, two were zonal hospitals, and the remaining six were general hospitals. Both inpatients and OPD patients were included in the study in the ratio of 1:4. The questionnaire was prevalidated on 50 patients at a hospital before the start of the study. To collect the data from the participants, a “Three-member Team” was formed for each hospital consisting of one male, one lady, and one doctor (who was not part of the hospital). All the teams were briefed and trained to collect the data. The questionnaire was self-administered if the participants could read and write English and in participants who could not read/write English, the responses were noted by the interviewer. In Section I of the questionnaire, there were 19 questions based on the physical infrastructure and facilities available in the hospitals, and Section II consisted of nine questions to assess the quality of medical care provided to the clientele. The last question pertained to the overall satisfaction of the patient.
For this study, it was presumed that the proportion of patient satisfaction was 0.5 and absolute allowable error was 6%. The sample size thus calculated was 267.[8] All patients who were more than 18 years of age and willing for the study were included. However, all those with psychiatric illnesses were excluded from the study.
The data for the first 28 questions were collected on a numerical scale from 5 to 1. All the questions in section I (19 questions) were graded ranging from “excellent” to “poor” on a numerical scale of 5–1 (excellent – 5; very good – 4; good – 3; satisfactory – 2, and poor – 1). All the questions in section II (9 questions) were graded ranging from “strongly agree” to “strongly disagree” on a numerical scale of 5–1 (strongly agree – 5; agree – 4; uncertain – 3; disagree – 2, and strongly disagree – 1).
For each question, the numerical response of each participant was entered in an Excel spreadsheet. Then, the number of each numerical response was calculated. The weighted average for each question was calculated. The weighted average of 2 and below was considered as poor satisfaction level, 2.01–3 as satisfactory, 3.01–4 as good, and 4.01–5 as very good. For question number 29, the participants were asked to choose one of the following three options – “very satisfied/just satisfied/not satisfied” – toward their overall experience in the hospital.
A total of 2850 patients were administered with the questionnaire with a minimum of 270 patients in each hospital. Data were analyzed using an electronic statistical package (IBM SPSS for Windows, Version 20.0. Armonk NY: IBM Corp.). The weighted average was calculated for each attribute.
| Results | | |
The overall satisfaction of the clientele is shown in [Table 1]. Ninety-five percent of patients were satisfied with the services provided by the hospitals. The percentage of patients who felt that the services were “very satisfactory” was 52% and “just satisfactory” was 43%. Only 5% of the patients were not satisfied. For the purpose of analysis, 28 questions were divided into five broad groups, namely, “infrastructure,” “waiting period,” “laboratory, radiology and dispensary services,” “personal care,” and “medical care.”
In respect to physical infrastructure, the general hygiene of the hospitals was marked “very good” with the weighted average of 4.12. Other ten attributes were marked “good” with weighted average ranging from 3.70 to 3.99 [Table 2]. The most unpopular attribute in the infrastructure was “quality of food” for inpatients (weighted average 3.74).
The weighted average in respect to the waiting period at reception and doctor's OPD was marked “good” with weighted average of 3.77 and 3.73, respectively [Table 3].
The laboratory, radiology, and dispensary services were marked “good” with weighted average ranging from 3.84 for “experience at USG/X-ray department” to 3.99 for “laboratory sample collection facilities” [Table 4]. | Table 4: Weighted average with respect to laboratory, radiology, and dispensary services
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In respect to personal care, three attributes, namely, “Co-operation at Reception,” “I am Treated in a Friendly and Courteous Manner” and “Para-medical Staff Manning Various OPDs and Wards are Helpful and Courteous” were graded “Very Good” with weighted average of 4.10, 4.07 and 4.10, respectively [Table 5].
As far as medical care was concerned, all the attributes were marked “Very Good” with weighted average ranging from 4.03 to 4.11 [Table 6].
Five strengths and weaknesses of the hospitals are enumerated in [Table 7].
| Discussion | | |
In our study, it has been observed that 95% of the clientele were satisfied with the services provided by the hospitals. Many studies in India, both in outpatient departments and wards, have assessed overall patient satisfaction. Patients visiting private hospitals have shown higher patient satisfaction than those visiting government hospitals. In a study conducted in a private tertiary care hospital in Mumbai, about 91% of inpatients reported that their experience in the hospital was good. The mean overall score (weighted average) was 4.32 against the maximum of five.[6] Two studies, one each in Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, and in an Urban Health Centre of Siliguri, have revealed that 73% of patients visiting outpatient departments were satisfied with overall services.[9],[10] Our study has shown one of the highest levels of overall satisfaction among various studies on patient satisfaction.
Infrastructure
In our study, general hygiene of the hospitals was marked “very good” rating by the clientele with weighted average of 4.12. However, the weighted average for “toilet facilities” was 3.85. Many studies have pointed out that the cleanliness of toilets was one of the major reasons for poor patient satisfaction. In a study conducted at the Indian Spinal Injuries Centre, only 69% of people were satisfied with the cleanliness of toilets.[1] In a tertiary care medical college hospital in Punjab, 62% of patients felt that the toilets were not maintained cleanly.[4] In yet another study conducted in an emergency department of Delhi hospital, 58% of patients were not satisfied with toilet hygiene and potable water facilities.[11] Apart from general hygiene and clean toilet facilities, availability of amenities such as comfortable seating facility, recreational facilities (TV and reading materials), and canteen play a major role in improving patient satisfaction. In our study, all the amenities have been marked “good” rating with a weighted average ranging from 3.84 to 3.99. In one of the private tertiary level urogynecological hospital in Central India, 94% felt that drinking water and toilets were available and the cleanliness was good.[12] This was one of the rare studies where toilet facility and general cleanliness have been marked “good” by more than 90% of patients.
Waiting period
Out of the total time spent by a patient in a hospital, large duration is spent on waiting at various places including reception, doctor's OPD, laboratory, and pharmacy. In our study, the weighted average in respect to the waiting period at reception and doctor's OPD was around 3.7. In a multispecialty government hospital in Jammu and Kashmir, 40% of the patients waited for less than 1 h; 52% waited for 1–2 h, and 9% for more than 2 h to see the doctor.[13] In a study conducted in the emergency department of Delhi hospital, only 57% of patients were satisfied with the waiting time to be examined by doctor.[11]
Laboratory, radiology, and dispensary services
Laboratory, radiology, and dispensary services are integral part of any hospital. In our study, the laboratory, radiology, and dispensary services were marked “Good” with weighted average ranging from 3.84 for “Experience at USG/X-ray Department” to 3.99 for “Laboratory Sample Collection Facilities”. In a tertiary care medical college in Punjab, 56% of patients stated nonavailability of medicine.[4] In a multispecialty government hospital in Jammu and Kashmir, 89% felt that medicines prescribed by doctors were available.[13]
Personal care
The ultimate aim of a health-care facility, whether government or private, is to treat the patients who visit the facility. Most of the time spent by the inpatients are with nursing and para-medical staff. In our study, co-operation at reception and the personal interaction with para-medical staff at OPDs have been marked very high with a weighted average of 4.10, whereas efficiency and courtesy of the nursing staff were marked the least (weighted average 3.98). In a study conducted in a superspecialty tertiary care center, 80% of the patients were satisfied with nursing services and 92% with the behavior of nurses.[1] However, in a study conducted in a government health-care facility in North East India, only 49% of patients were satisfied with the thoroughness of care provided by nursing staff.[3]
Medical care
In a hospital, most part of medical care revolves around the doctor. Hence, the treatment of a doctor, particularly the time spent by the doctor, advice given by the doctor, and explanation given by the doctor regarding investigation and treatment play a key role in improving patient satisfaction. In our study, all attributes on medical care were marked “very good” with a weighted average above 4. In Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, 73% of patients were satisfied with overall services, however 97% of the patients were highly satisfied with doctors.[9] In a private tertiary level hospital in Central India, where the overall patient satisfaction was very high, 94% of the inpatients said that the time given by doctors was satisfactory; 96% were extremely satisfied with the disease description; 98% said that the perception of efficiency of doctors and the details of investigation discussed were excellent, and 90% felt that the number of visits by doctors was adequate.[12]
In our study, the strengths of the hospitals were the general cleanliness and the way the medical and paramedical staff treat their patients. However, patients were least satisfied with the waiting period at reception and to see the doctor as well as the quality of food provided to the inpatients. It is vital that the hospitals need to reduce the time taken by the patients at reception by increasing the number of staff during peak hours. This would drastically reduce the time spent by the patients at reception. As far as the time spent at OPDs to see the doctors, it may not be cost-effective to increase the number of doctors. However, the hospitals may introduce technology such as online registration system, which could be computer based or SMS based. This would also reduce the overcrowding in OPDs and evenly distribute the patient load.
As far as food served to the patients is concerned, the food served to the patients needs to be fresh, nutritious, and tasty. Furthermore, it is important to serve the food on time. Hence, the hospitals may employ a nutritionist and well-qualified chefs. This step would go a long way in improving the quality of food served to the patients, thereby to improve the patient satisfaction.
| Conclusion | | |
This study has brought out that a large percentage of patients were satisfied with the services provided by the hospitals and helps to identify the strengths and weaknesses of the hospitals. It is essential that the administration of the hospitals addresses the weaknesses to further improve the patient satisfaction. It is, therefore, concluded that patient satisfaction survey is an important tool to understand the patients' needs and to identify the areas which require improvement. Hence, it is recommended that patient satisfaction survey should be an essential instrument and an ongoing process rather than an one-time measure in any health-care facility which strives to improve patient satisfaction.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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