N (%)
Abbreviations: BPL, below poverty line; INR, Indian National Rupees; IPD, inpatient department; OPD, outpatient department.
Participants had mean age of 34.6 ± 12.6 years, majority had education above secondary level (60%), were married (87%), housewives (35.4%), and above poverty line (89%). Around 75% of the participants had monthly household income above 7000 INR ( Table 2 ).
Less than 5% of the OPD participants rated speed of registration as either poor or very poor. Similarly, very few were dissatisfied with courtesy of the staff in the registration area with less than 3% rating them as either poor or very poor. Majority were also satisfied with other domains of registration like comfort of the waiting area, waiting time before going to check-up room, comfort and pleasantness of the check-up room, friendliness/courtesy of the nurse/assistant, concern the nurse/assistant showed for the problem, and waiting time in the exam room before being seen by the care provider ( Table 3 ).
Rating of different aspects of registration process by OPD participants.
Variables | Excellent N (%) | Good N (%) | Fair N (%) | Poor N (%) | Very poor N (%) | |
---|---|---|---|---|---|---|
1. | Speed of registration | 904 (27.6) | 1305 (39.8) | 909 (27.7) | 144 (4.4) | 16 (0.5) |
2. | Courtesy of staff in the registration area | 958 (29.3) | 1336 (40.7) | 883 (26.9) | 97 (2.9) | 4 (0.1) |
3. | Comfort and pleasantness of the waiting area | 913 (27.8) | 1084 (33.1) | 1069 (32.6) | 200 (6.1) | 12 (0.4) |
4. | Length of wait before going to check-up room | 890 (27.2) | 1249 (38.1) | 893 (27.2) | 227 (6.9) | 19 (0.6) |
5. | Comfort and pleasantness of the check-up room | 953 (29.1) | 1174 (35.8) | 963 (29.4) | 179 (5.5) | 9 (0.3) |
6. | Friendliness/courtesy of the nurse/assistant | 1050 (32.0) | 1470 (44.8) | 664 (20.2) | 89 (2.8) | 5 (0.2) |
7. | Concern the nurse assistant showed for your problem | 1043 (31.8) | 1149 (35.1) | 947 (28.9) | 132(4.0) | 7 (0.2) |
8. | Waiting time in the exam room before being seen by the care provider | 951 (29.0) | 1162 (35.4) | 1000 (30.5) | 149 (4.5) | 16 (0.6) |
Abbreviation: OPD, outpatient department.
Majority of the participants were satisfied with various aspects of care provision like friendliness/courtesy of the care provider, explanations the care provider gave about the problem, concern the care provider showed for the questions or worries, care provider’s efforts to include the patient in decisions about the treatment, information the care provider gave about medications and follow-up care, and so on ( Figure 1 ).
Rating of the various domains of care received from the care provider by the OPD participants.
OPD indicates outpatient department.
Overall, majority (80%) were satisfied with the care received from the care providers with less than 3% being either completely or somewhat unsatisfied.
Majority of the participants were satisfied with the various personal issues like convenience of hospital/health facility hours, sensitivity shown to the needs and concern shown for privacy. However, around 7% of the participants rated the degree of safety/security at the hospital/health facility as poor or very poor ( Figure 2 ).
Rating of various domains of personal issues and laboratory/radiology services by the OPD participants.
A total of 693 (21.1%) out of the 3278 OPD participants availed laboratory/radiology services from the concerned health facilities. Major domains of dissatisfaction were waiting time for lab tests (51.2% rating it as either poor or very poor), waiting time for x-rays (58.8% rating it as either poor or very poor), concern shown for patient’s comfort during the lab tests (47.3% rating it as either poor or very poor), and concern shown for patient’s comfort during x-ray (31.9% rating it as either poor or very poor) ( Figure 2 ). However, majority were satisfied with the dealing of staff during the lab/radiology tests with only around 7% only being unsatisfied.
In the OPD, majority were satisfied with the politeness of the hospital staff as only 1.8% of the participants rated it as poor or very poor. Only 6% of the respondent rated overall cleanliness of the hospital/health facility as poor or very poor. Similarly, majority (72.2%) rated the overall care received during the visit as either good or very good and only 4.8% of the participants said that their likelihood of recommending the hospital to others was poor or very poor ( Figure 3 ).
Various experiences of the IPD participants during hospital stay.
IPD indicates inpatient department.
Mean age of participants from IPD was 36.56 ± 21.23 years with majority being in age range of 31 to 50 years. Around 59% of participants had education above secondary level. About 11% of participants were below poverty line (BPL) and monthly household income was more than INR 7000 for approximately more than 75% of the participants ( Table 2 ).
Majority (78.2%) of participants reported to be satisfied with overall care received from nurses with less than 3% being unsatisfied ( Figure 3 ). The nurses treated the participants with courtesy, listened to them carefully, and explained the things in an understandable way and participants got help as soon as wanted from the nurses as less than 1% of total participants answered to these questions as never ( Table 4 ).
Rating of different domains of care received from nurses and doctors and of the hospital environment by the IPD participants.
Variables | Always N (%) | Usually N (%) | Sometimes N (%) | Never N (%) | |
---|---|---|---|---|---|
1. | How often did nurses treat you with courtesy and respect? | 731 (45.3) | 739 (45.8) | 130 (9.9) | 14 (0.9) |
2. | How often did nurses listen carefully to you? | 798 (49.4) | 706 (43.7) | 99 (6.0) | 13 (0.9) |
3. | How often did nurses explain things in a way you could understand? | 836 (51.8) | 626 (38.8) | 138 (8.5) | 14 (0.9) |
4. | How often did you get help as soon as you wanted it from hospital staff? | 829 (51.4) | 632 (39.2) | 142 (8.7) | 11 (0.7) |
5. | How often did doctors treat you with courtesy and respect? | 801 (49.6) | 728 (45.1) | 80 (4.9) | 5 (0.3) |
6. | How often did doctors listen carefully to you? | 889 (55.1) | 667 (41.3) | 53 (3.3) | 5 (0.3) |
7. | How often did doctors explain things in a way you could understand? | 881 (54.6) | 570 (35.3) | 157 (9.7) | 6 (0.4) |
8. | How often your room and bathroom were kept clean? | 650 (40.3) | 761 (47.1) | 168 (10.4) | 35 (2.2) |
9. | How often was the area around your room quiet at night? | 939 (58.2) | 567 (35.1) | 97 (6.0) | 10 (0.7) |
Abbreviation: IPD, inpatient department.
Similarly, majority (80%) of the participants reported satisfaction with the overall care received from the doctors with less than 2% being unsatisfied. The doctors treated the participants with courtesy and respect, listened to them carefully, and explained things in an understandable way to the patients ( Table 4 ).
Around 2% of participants reported that room and bathrooms were never clean and another 10% reported them to be clean sometimes only. Similarly, around 1% and 6% of the participants replied that area around their room was never or only sometimes quiet at night, respectively ( Table 4 ). Overall, only 46% of the participants were satisfied with the hospital environment.
With domains of other experiences during hospital stay, out of 130 patients who required help going to bathroom or using a bedpan, 23.1% of the participants told that they never got help from nurses or other hospital staff and around 21% replied as getting the help sometimes only. Similarly, among the 658 patients requiring medicines for pain, around 1% and 6% of them reported to have never having pain well controlled and having pain controlled sometimes, respectively. Out of 729 participants who said they were given medicines which they had not taken before, around 5% and 14% of participants replied that they were never and sometimes only told what the medicine was for, respectively. Around 35% of the participants who were given any new medicines replied that they were not told about the possible side effects of the medicines in a way they could understand. However, 84% of the inpatient participants were satisfied with the availability of medicine in the hospital/health facility and around 71% of them were likely to recommend the hospital/health facility for admissions to others ( Table 4 )
Measurement of patients’ satisfaction is important for improving services and strategising goals for all health care organisations. 19
In our study, majority (97%) of OPD participants were satisfied with overall care received. This is much higher than found in some of the other studies from developing world. 20 - 26 Previous studies from India have reported patient satisfaction score ranging from 60% to 88%. 27 - 31 Higher level of satisfaction among the OPD participants in our study may be attributable to availability of free medicines and low cost of laboratory tests. Politeness and courtesy are context and culture specific and cannot be directly compared across cultures. However, it is important that the clients perceive the behaviour of service providers as acceptable.
A vast majority (98%) of the participants in our study were satisfied with overall politeness of the hospital/health facility staff and around 95% of the OPD participants were likely to recommend the hospital/health facility to others. In a study to assess the level of satisfaction of patients attending a public tertiary hospital in Nigeria, 78.5% of the participants were satisfied with the hospital services and 91.7% were likely to recommend the health facility to a friend. 22 In another study to assess degree of clients’ satisfaction among patients attending government health facilities in rural Bangladesh, only 68.9% of the participants expressed satisfaction with the provider’s usual behaviour. 23
Around 7.5% of OPD participants were dissatisfied with long waiting time for consultation. In the study to evaluate patients’ satisfaction with quality of care provided at National Health Insurance Scheme (NHIS) clinic of a tertiary hospital in South-Eastern Nigeria, 48.3% of participants were dissatisfied with long waiting time. 24 In a study from Bangladesh, 28.2% of users were not satisfied with the time they waited to receive care. 23 In another study to assess client satisfaction with health services of a specialised tertiary care Centre in Ethiopia, dissatisfaction was reported to be highest (46.9%) by participants with waiting time. 25
In our study, majority (98%) of OPD participants were satisfied with overall care received from care provider and majority (97%) were also satisfied with time the care providers spent with patients. In a study assessing satisfaction of patients with primary health care services in Saudi Arabia, 16.7% of satisfied and 38.9% of dissatisfied clients complained that physicians did not satisfactorily explain their health problems and treatments. 26 In contrast, 96% of OPD participants in our study were satisfied with explanation the care provider gave to them about their problems and 95% could understand the words used by care providers.
In our study, majority (97.2%) of the OPD participants found the hospital/health facility hours convenient. Around 95% were satisfied with concern shown for their privacy. This is in contrast to a study from Bangladesh where a significant proportion of users (34.2%) were unsatisfied with the length of time the facilities were open to the public and only 45.1% of the clients were satisfied with the privacy maintained at the health facility. 23
With inpatient services, 78% of participants reported to be satisfied with overall care received from nurses and 80% of participants reported to be either completely or somewhat satisfied with care received from the doctors. In the study by Rajkumari and Nula 32 done in a tertiary care health facility from North East India and by Malangu and Westhuisen 33 done in a DH of South Africa, 32.5% and 50% of the patients, respectively, were satisfied with the overall inpatient care which is lower than seen in our study. In another study by Mishra and Mishra 34 conducted in a tertiary care private hospital of North India, the nursing services satisfied 80% of the participants while 92% were satisfied with explanation about disease and treatment by doctors. However, in the same study, behaviour of nurses, doctors, and orderlies satisfied 92%, 92%, and 83% of people, respectively. 34 The somewhat higher level of satisfaction with the behaviour of nurses and doctors in the above study compared to ours might be due to differences in the study populations and the different study settings.
Another study done among patients admitted to obstetrics and gynaecology wards of public hospitals of Ethiopia reported overall satisfaction rate of 79.7% similar to our findings. 35 However, concerning hospital staff informing to clients what the medicine was before giving new medicine, describing possible side effects of the medications in ways clients could understand, and cleanliness of toilet and washroom were the areas in which clients were dissatisfied in the study similar to our findings. 35
With respect to hospital environment, around 46% of participants were satisfied with hospital environment, with 12% reported problem with cleanliness of toilets and rooms and 7% reported problem with quietness during night. Similar findings were reported by Mishra and Mishra 34 in their study in which only 49% of the inpatients were satisfied with cleanliness of the toilets. However, in the study by Malangu and Westhuisen, 33 80% of participants were happy with cleanliness of wards, bedding and ablution facilities, as well as safety at night. The results of this study confirm that perception and judgement of quality are highly individualistic, dynamic and consequently client satisfaction has an important reflection on the quality of health care process.
Majority of patients using outdoor and indoor services were satisfied with the care received and the behaviour of the received and behaviour of hospital staffs. Registration process needs to be streamlined to reduce waiting time and delays. In laboratory services, particularly the waiting time may be reduced and patients’ comfort during lab tests and x-ray may be improved for improving satisfaction of clients. Majority of participants, both OPD and IPD, agreed that behaviour of hospital staff was good, doctors and nurses spent adequate time with patients, and detailed information about illness and treatment was provided to them by doctors. Attention should be given to the perceived feeling of lack of personal security and cleanliness at health facilities. Before prescribing a new medicine to a patient, the possible side effects and purpose of giving the medicine should also be explained to them. Finally, a system for clients’ feedback may be institutionalised at all health facilities to improve quality of care.
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the National Health Mission Research, Punjab. The funders had no role in the conduct of study and writing of manuscript of publication.
Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Author Contributions: MK: Conceptualization, Data collection and analysis, Manuscript writing and approval; AB: Data collection and analysis, Manuscript writing and approval; TS: conceptualization, Data collection and analysis, Manuscript writing and approval; RK: conceptualization, Data collection and analysis, Manuscript writing and approval.
Supplemental material: Supplemental material for this article is available online.
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The bibliometric analysis revealed the countries, institutions, documents, authors, and sources most productive and significant in patient satisfaction. Discover the world's research 25+ million ...
(1) Background: Patients' experiences and satisfaction with their treatment are becoming increasingly important in the context of quality assurance, but the measurement of these parameters is accompanied by several disadvantages such as poor cross-country comparability and methodological problems. The aim of this review is to describe and summarize the process of measuring, publishing, and ...
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Objective: Although patient satisfaction is increasingly used to rate hospitals, it is unclear how patient satisfaction is associated with health outcomes. We sought to define the relationship of self-reported patient satisfaction and health outcomes. Design: Retrospective cross-sectional analysis using regression analyses and generalized ...
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Background In 2016 the Malawi government embarked on several interrelated health sector reforms aimed at improving the quality of health services at all levels of care and attain Universal Health Coverage by 2030. Patient satisfaction with services is an important proxy measure of quality. We assessed patient satisfaction at a tertiary hospital in Northern Malawi to understand the current ...
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A Method for Surveying Patient Satisfaction: Manual for Users, Clinical Governance Research and Development Unit, Department of General Practice and Primary Health Care, University of Leicester. Carr-Hill, R. (1992). The measurement of patient satisfaction. Journal of Public Health Medicine,14 (3):236-249.
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