Patient reported experience measures: an assessment of the in-patients in a tertiary care teaching hospital

INTRODUCTION

Healthcare institutes have been under the impression for many decades that patient satisfaction is the ultimate measure of the success of hospital healthcare services.¹ Consumers have high expectations and demands because of improved socioeconomic status and easy accessibility to medical care. The patients have certain expectations before hospital visits, and they either become satisfied or dissatisfied after visiting the hospital and experiencing the facilities.²

Patient experience goes beyond patient satisfaction. Patients' perceptions about the healthcare system are being ignored by healthcare managers in developing countries. Patient experiences related to communication with the doctors and nurses, hospital environment, ambience and cleanliness of the patient care areas, responsiveness of the staff, communication by the concerned regarding medications, discharge process and overall rating of the hospital are required to be assessed and measured. This will guarantee quality care for the patients along with safe patient care. In the current scenario, where the hospital is recognized as a social institute, and the patient is the only reason for its existence, the hospital must strive for patient-oriented services. The expectations that a patient has from the healthcare sector and the instances where the healthcare sector meets those expectations play a crucial role in determining the success of a healthcare institute.

Satisfaction with the physicians, nurses, facilities and equipment, housekeeping, billing, and food services are the main determinants of overall patient satisfaction.³ Health care service quality is shown to be experienced in various ways. Identifying and describing these different ways of experiencing health care service quality provides practitioners with strategic insight into improving the quality of service they provide outside the realm of objective satisfaction measures. The patient is the one who decides the quality, who accepts the services, who make others get them, who give correct feedback about the performance of the hospital, and who makes the program of total quality management successful.⁴ Therefore, assessing patient perspectives gives them a voice, making public health services more responsive to people's needs and expectations.⁵

Patient experience measures may be sensitive to differences in quality care across different providers, institutions or time, and thus can be used to identify gaps or evaluate changes in quality resulting from interventions or policies.⁶ Patient experience is a process indicator and reflects the interpersonal aspects of quality of care received. This indicator is broadly composed of three domains: effective communication; respect and dignity; and emotional support.⁷

The objective of this study was to assess the different levels of patient experiences and also to determine the factors that are affecting the satisfaction level for the services provided to the patients.

METHODS

Study design

Our study was conducted using a descriptive, cross-sectional research design. The data is collected through a structured questionnaire administered to patients in the inpatient department of the selected hospital who were in the final stage of the discharge process.

Sampling and sampling techniques

The data was collected from all the patients (977) who were discharged during the study period.

Tools and techniques of data collection

The study was conducted using a structured, close-ended questionnaire to collect patient data.

Data collection method

A structured questionnaire was made and given to the patients after receiving Ethical clearance from the Ethics Board of the institute where in the study was conducted.

Study period

The study was conducted from 1^st January 2023 to 31^st January 2023.

Inclusion criteria

All in- patients who could communicate in English or Kannada were taken for the study. Patients who had availed in patient services in the month of January 2023 were taken for the study.

Exclusion criteria

Opinion of the patient bystander was not included. Patients who had availed day care facility were excluded from the study

Content validity

The tool was given to experts for content validity. Based on their suggestions and recommendations, the tool was modified.

Plan for data analysis

The collected data were analyzed by frequency, percentage, mean, and standard deviation based on the study's objectives. The data were presented graphically as well as in the form of tables.

RESULTS

This section looks at the information from structured questionnaires filled out by 977 patients and tries to determine experiences of the in-patients during their treatment in the selected hospital. The results of the analysis are shown in tables and graphs. The representation of results is listed in five sections.

Part A: Experience of the patients with regards to the level of services received from the doctors.

Part B: Experience of the patients with regards to the level of services received from the nurses.

Part C: Experience of the patients with regards to the auxiliary services availed.

Part D: Experience of the patients with regards to the communication of the staff in the hospital.

Part E: Experience of the patients with regards to the infrastructure and other amenities available in the hospital.

Our study shows that 66.4% of the respondents strongly agreed that the doctors had explained the treatment plan clearly, and 32.3% agreed that the doctors had explained the treatment plan clearly. Only 1% of the respondents had a neutral opinion regarding the level of explanation regarding the treatment plan from the doctors. The majority (63.4%) of the respondents opined that they strongly agreed that all their concerns were addressed satisfactorily, and 34.8% of the respondents opined that the doctor addressed all their concerns satisfactorily. The majority (66.5%) of the respondents strongly agreed that the overall care and treatment were good and 31.5% of the respondents agreed that the overall care and treatment were good, and only 1.8% had a neutral response (Table 1).

About 64.3% of the respondents opined that they strongly agree that the nurses had clearly explained the medications and procedures such as IV injections, blood withdrawal, etc. 33.3% of the respondents agreed that the nurses had explained the medications and procedures clearly. 2.1% of the respondents had a neutral response, and 0.2% strongly disagreed that the nurses had explained the medications and procedures clearly. 62.7% and 34.8% of the respondents opined that they strongly agreed and that the nurses addressed all their concerns satisfactorily. However, 0.3% of the respondents disagreed that their concerns were addressed satisfactorily. The majority (63.4%) of the respondents strongly agreed that the overall care and treatment by the nurses was good. Although 2.7% of the respondents had a neutral response, 2.9% said that they disagreed that the overall care by the nurses was good (Table 2).

It is noted that 38.1% and 58% of the respondents agreed and strongly agreed that the reception/registration counter staff were courteous. 0.5% of the respondents disagreed that the staff at the reception were courteous. The study showed that 54% of the respondents strongly agreed that the service rendered at the billing counter was good, whereas 40.6% agreed that the service provided at the billing counter was good. However, 4.5% of the respondents opined as neutral. 49.4% of the respondents had opined that they strongly agreed that the food served by the hospital cafeteria was excellent and hygienic. Although 8.5% of the respondents had a neutral opinion, 2.1% disagreed that the food served in the hospital cafeteria was excellent and hygienic (Table 3).

Regarding communication regarding the cost of treatment, 53.5% of the respondents strongly agreed that the approximate cost of treatment was explained to them. 6.2% of the respondents had a neutral opinion regarding the approximate cost of treatment that was explained. However, 2% of the respondents disagreed regarding the accuracy of the treatment cost explained to them. 53.7% of the respondents strongly agreed that the information provided regarding the hospital services was clearly explained. When 40.6% of the respondents opined that they agreed that the information regarding hospital services was clearly explained, 5% opined neutral. 55.4% and 40.4% of the respondents strongly agreed that the display boards regarding patient rights and responsibilities were clear. However, 3.5% of the respondents had a neutral opinion regarding the display boards, and 0.4% disagreed that the display on patient rights and responsibilities was clear. 60.5% and 35.3% of the respondents strongly agreed. They agreed that all necessary information, medication orders, revisit date, and when and how to contact in an emergency were provided during discharge. However, 3.5% of the respondents had a neutral response, and 0.5% of the respondents disagreed with the same (Table 4).

It was observed that 65.1% of the respondents strongly agreed that the hospital surroundings and wards were clean. When 31.9% of the respondents agreed that cleanliness was maintained in the hospital ward and surroundings, 2.5% opined neutral. 61.6% of the respondents strongly agreed that the drinking water facility was adequate. However, 1.3% of the respondents disagreed with the statement. Of the respondents, 61.3% strongly agreed that the toilets and bathrooms were clean.

3.5% of the respondents had a neutral response to the statement. 58.6% and 37.9% of the respondents strongly agreed and agreed that adequate privacy was maintained during procedures. 60.3% of the respondents had opined that the hospital environment is quiet and calming; however, 0.8% of the respondents disagreed with the same (Table 5).

Nearly 94% of the respondents opined that the overall satisfaction of the treatment received was excellent, and only 0.4% of the respondents had opined poor satisfaction. 93.8% of the respondents had opined an excellent level of satisfaction regarding the overall quality of service, and only 0.7% of the respondents had opined a poor quality of service. 94.3% of the respondents had opined that they would recommend this hospital to others (Table 6 and 7).

DISCUSSION

This study aims to assess the different levels of patient experiences and also to determine the factors that are affecting the satisfaction level for the services provided to the patients. The study significant findings of the study were as follows.

About 66.4% of the respondents strongly agreed that the doctor’s treatment plan was clears and 63.4% of the respondents had opined that all their concerns were addressed satisfactorily. Studies have shown that patient satisfaction is positively associated with patient trust, doctors' interpersonal skills, and communication behaviour.⁸ In order to increase the patient positive experience level, it was advised that doctors be trained regarding effective communication with the patients. It was also advised that the practice of self-introduction by the doctors to the patients before examination or conducting a procedure should be adopted. The study data showed that 66.5% of the respondents strongly agreed that the overall care and treatment of the doctors were good.

Of the respondents, 64.3% strongly agreed that the nurses had clearly explained the medications and procedures, such as injections, blood withdrawal, etc.; 62.7% strongly agreed that the nurses had addressed all their concerns satisfactorily. The study showed that the overall care and treatment by the nurses provided was good (63.4%). It was suggested that the nurses are sensitized regarding the need and importance of addressing all the patient's concerns, even for minor procedures like blood withdrawal, checking vitals, etc. It was also suggested to incorporate the same during the biannual training for the nurses. A questionnaire based study was conducted by Mahesh et al, where views of inpatient were taken regarding various clinical and support services, to assess the level of satisfaction of in-patients at tertiary care specialty hospital. The study recommended for the need to develop soft skills among doctor and paramedics and to improve upon the level of cleanliness and quality of dietary services.⁹

The study showed that only 58% of the respondents strongly agreed that the staff at the reception/registration were courteous. It is suggested that the selected hospital takes proactive measures to improve the patient experience level of this index. Simulation-based training can be adopted in order to train the staff to address the patients and hospital visitors in a courteous manner. The study also showed that 54% of the respondents had opined that they strongly agreed that the service by the billing counter was good. They suggested that all the patients be counselled regarding the discharge process, including the estimated time taken. This can help change the patient's perspective regarding the billing counter for the delay caused in processing the final bill. Also, the selected hospital management suggested that proactive measures are undertaken to ensure no delay in the discharge process.

The study showed that 49.4% of the respondents strongly agreed that the food served by the hospital cafeteria was excellent and hygienic. On further intervention, it was noted that patients had concerns regarding the price of the food items in the hospital cafeteria. Hence the hospital management was suggested to review the rates in the best possible manner for the inpatients.

About 53.5% of the respondents strongly agreed that the approximate cost of treatment was explained to them. In order to improve patient experience in this regard, it also suggested that the doctors, patient coordinators, and billing staff collaboratively ensure that patients are counselled regarding the cost of treatment on time. Written documentation regarding financial counselling needs to be maintained in all situations. 53.7% of the respondents strongly agreed that the information provided regarding the hospital services was clearly explained, and 55.4% of the respondents strongly agreed, that the display boards regarding patient rights and responsibilities were clear. The pamphlets be made regarding various facilities and amenities available in the hospital to all the patients during discharge. 60.5% of the respondents strongly agreed that all information required during discharge, including medications, revisits, and emergency contact, be given. The hospital quality control team conducts regular audits to ensure that all the patients follow all practices. The committee meetings can discuss the compliance rate, and regular measures can be maintained to ensure 100% compliance.

The study showed that 65.1% and 61.3% of the respondents strongly agreed that the Hospital surroundings and wards were clean, including the toilets and bathrooms. Suggestions were made by the patients in order to fix a specific time for cleaning so that they could expect the housekeeping staff at the time. 61.6% of the respondents strongly agreed that the drinking water facility was adequate. 58.6% of respondents strongly agreed with adequate privacy during procedures. Furthermore, nurses and doctors should be sensitive regarding privacy during procedures, especially in general wards. 60.3% of the respondents strongly agreed that the hospital environment is quiet and calming.

A study was conducted in Mysore by Raju et al, that major satisfiers were quality and behavior of doctors, explanation about disease and treatment by the doctors, courtesy of staff at the admission counter, behavior of nurses, timely discharge process. Dissatisfies were lift operators’ guidance, the behavior of the security guards, quality of food and dietary services, explanation about hospital charges and costs in the billing counter, cleanliness maintained in the hospital.¹⁰ The current study showed that the overall satisfaction of the treatment received was excellent, 93.7% of the respondents. Equal percentage of the respondents opined that the overall quality of service was excellent. 94.3% of the respondents said they would recommend the selected hospital to others. The experience of the patients regarding the service rendered by the hospital is good. The hospital must undertake proactive measures as suggested to ensure continuity of positive patient experience and an increase in patient satisfaction. A study conducted in 2022 recommended that the hospital management should closely work together with health professionals, supportive staff, patients, and other concerned stakeholders to improve admitted patients’ satisfaction with the quality of care. Policymakers were advised to develop and institutionalize better interpersonal relations in the health system.¹¹

This study has few limitations. The study does not capture experiences of the patients based on the type of clinical care received. Assessment of the experience of the patient based on the procedures or surgery that they underwent and also based on the clinical department that they were admitted under will significantly help in understanding the patient reported experience measures.

CONCLUSION

Rapid transformation is being undertaken in the healthcare industry in order to meet the increasing needs and demands of patients. The patient satisfaction level plays a pivotal role in enhancing the patient experience and delight during their hospital stay. The hospital management advised constantly measuring patient experience in this competitive healthcare industry. The patient's expression of their experiences with the hospital's services can be a judgment on the quality of care provided by that hospital. The current study suggested that the majority of the In- patients are delighted with the various services provided by the hospital. However, to provide better patient experience, increase patient satisfaction and maintain a higher level of satisfaction, the hospital management should undertake the suggested measures. Regular measurement of patient experiences and timely proactive intervention for increasing patient satisfaction will enrich the patient experience in the hospital, which will lead to patient delight.

ACKNOWLEDGEMENTS

We would like to thank the patients of the selected tertiary care teaching hospital for sharing their views and inputs for this study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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